by Marcin Gornsiewicz, M.D.
“One day in late 1850’s Dr. Maurice Raynaud had a new patient, a young, healthy French girl, and noticed her fingers suddenly becoming pale and cold.”
It is getting colder every day. Winter is around the corner. Our body adjusts to new weather conditions accordingly. Blood vessels supplying the skin narrow in response to cold temperatures to minimize heat loss and keep the body’s core warm. This is called vasoconstriction and is controlled by the sympathetic nervous system, the same system that is also activated when we are nervous or upset. Cold hands and feet are then normal physiological response to both cold exposure and emotional stress. Unfortunately, sometimes this system overreacts and vessel constriction becomes exaggerated.
One day in late 1850’s Dr. Maurice Raynaud had a new patient, a young, healthy French girl, and noticed her fingers suddenly becoming pale and cold, causing a great amount of pain. He then collected several similar cases and published his thoughts in 1862. This apparently quite common condition is now known as Raynaud’s phenomenon or simply Raynaud’s (please don’t confuse with french car Renault or french painter Renoir).
So, what exactly is happening? Blood supply to the fingers and/or toes becomes inadequate due to spasms of blood vessels in a relatively minor cold environment or during emotional events. This leads to series of discolorations, a three-phase color sequence (white to blue to red). First, the fingers blanch white due to lack of blood flow (pallor). Then the blood that is left in tissue loses its oxygen and digits turn blue (cyanosis). Finally, the blood vessels reopen and fresh oxygenated blood returns, which turns the fingers red (rubor). This phenomenon can last from less then a minute to several hours. There may be considerable pain, throbbing, numbness or tingling. In rare cases skin ulcers may develop. It can be triggered by cold, for instance holding a glass of ice water, getting stuff from the fridge, walking into an air-conditioned store or even by a slight change in temperature like a cool breeze in the middle of summer. Please remember that not everyone will experience all three colors but Raynaud’s is not just the cold hands and feet.
Raynaud’s can happen to anyone at any age but most frequently affects women, especially in their 20’s and 30’s. It is rare in kids younger then 10. Teenage girls between 12 and 16 are frequent patients in rheumatology clinics. Most of the young people are otherwise healthy and in majority of cases symptoms disappear in the early twenties. This is called primary Raynaud’s as oppose to secondary Raynaud’s. In the latter there is an underlying disease or condition that predisposes to abnormal vasospasm. Although it is less common and appears later in life (around 40), it tends to be more serious. Systemic autoimmune diseases especially scleroderma and lupus are likely the cause of secondary Raynaud’s. Smoking and certain medications including drugs used to treat migraines and over-the-counter cold medicines could trigger vasospasm as well. There are some clues that favor more serious conditions and require careful evaluation by rheumatologist. Those include:
- late onset after 40 especially in men
- painful, ischemic ulcers at the tips of fingers or toes
- signs and symptoms of another disease
- abnormal laboratory tests suggesting an autoimmune disease (especially ANA anbibody)
So, what should be done if your teenage daughter has Raynaud’s?
Just use common sense. Keep her whole body but especially her hands and feet warm. Keep the house at an even temperature. Watch out for open windows and doors. Remember that it is the change in temperature rather then simply the cold that triggers Raynaud’s. During the cold season warm up any clothing, gloves and socks before going out. A hair dryer can help. Chemical hand warmers inside gloves or mittens, and heavy wool stockings may also do the trick. Forget about shorts and flip-flops. Several layers of clothing is preferable. Hats are very important because a great deal of body heat is lost through the scalp. Avoid touching cold objects. Protect hands when reaching into the fridge. Smoking is out of discussion. Caffeinated products are not recommended, and forget about energy drinks and sodas, including diet sodas. Eat several small meals to maintain a constant energy level and have at least one hot meal a day. Some natural products like fish oil, ginkgo biloba, ginger tea are helpful. Exercise is good, because it helps maintain better blood flow. Outdoor activities, even in the middle of winter, should be encouraged. Just remember that a few simple precautions will make a big difference in your child’s comfort.
Dr. Marcin Gornisiewicz graduated with an MD degree from the Medical School of Warsaw in Warsaw, Poland. He completed residency training in internal medicine at Saint Barnabas Medical Center in Livingston, New Jersey. He completed fellowship training in rheumatology at the University of Alabama at Birmingham in Birmingham, Alabama. He joined Rheumatology Consultants, PLLC (rheumatologyconsultants.org) in 2002. He is board certified in Rheumatology.