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December 8th, 2018

Cold Hands - Innocent or Not?


Who Gets Cold Hands?

Cold hands or feet in wintertime are commonplace.  Sometimes, however,cold hands can be a sign of something more serious.  Here are things you need to know about what is innocent, serious, or emergent.


When It’s Innocent

Cold hands can be a normal response to stress.  Under stress, the body tends to divert blood away from the skin and peripheral areas of the body in order to better supply muscles and vital organs.


Intense cold hands also occur in response to decreased temperature.  First, cold is a stress.  Second, heat dissipates more rapidly from peripheral and well-perfused areas of the body as hands, feet, and head.  Third, the body responds to this heat loss by decreasing circulation to the hands and feet in order to reduce the heat loss.


But about 10% of people have an exaggerated response to stress and especially to cold.  This is called “primary Raynaud phenomenon.”  In addition to feeling cold, the hands or feet often exhibit a color change that begins with white, then becomes blue, and finally, shifts to red when circulation returns.  Pain, tingling, or numbness may also occur in the affected area.


These changes are bilateral and symmetric, i.e., they occur to a similar extent and at the same time on both left and right.  Women are more subject to these changes than men.  The phenomenon often begins in a person’s teens or twenties and tends to persist.


This situation is innocent when the episodes are short-lived, reverse rapidly on rewarming, and involve no other changes.  The phenomenon very rarely becomes serious when the decreased blood flow to the affected area results in tissue damage.  Some evidence suggests that persons exhibiting the Raynaud phenomenon have a somewhat increased risk of cardiovascular disease.


When It’s Serious

Raynaud phenomenon is serious when it is associated with tissue damage and when there is an identifiable underlying cause.


The underlying cause can be an occupational disease, blood disease, autoimmune disease, infectious disease, metabolic disease, malignant disease, or even a medication.


Some of the occupational causes are past frostbite, or other injury, use of vibrating tools, lead or arsenic exposure, and exposure to organic solvents such as polyvinyl chloride, xylene, toluene, or acetone.


Some blood diseases associated with the phenomenon are polycythemia, cryofibrinogenemia, and paroxysmal nocturnal hemoglobinuria.


Autoimmune diseases implicated in the phenomenon are scleroderma, lupus erythematosis, rheumatoid disease, vasculitis, and Sjøgren Syndrome.


Infectious diseases associated with Raynaud phenomenon are hepatitis infections associated with cryoglobulinemia and Mycoplasma infections with cold agglutinins.


Metabolic diseases with links to Raynaud phenomenon are diabetes mellitus, pheochromocytoma, myxedema, and acromegaly.


Malignant diseases related to Raynaud phenomenon are leukemia, lymphoma, myeloma, and adenocarcinoma of the lung.


Finally, even medications can be associated with Raynaud phenomenon.  Some of these are oral contraceptives, ergot alkaloids, beta-blockers, cyclosporin, methylphenidate, and some cancer chemotherapeutics.


When It’s an Emergency

Of course, a white or blue color change that doesn’t rapidly reverse, or that reverses and then becomes painful or numb, is an emergency.  This is especially true  if the affected area had become white and hard or if it had been subjected to prolonged immersion in cold water.  The problem here may be frostbite, thromboangitis obliterans, or arterial embolus.  These circumstances warrant a trip to the hospital emergency room.


What To Do

The treatment for Raynaud phenomenon depends on whether it is innocent, serious, or an emergency.


The treatment for innocent Raynaud phenomenon is straightforward.  Insofar as possible, avoid exposure to cold air, cold liquids, and cold surfaces.  Wear substantial gloves, or preferably mittens, and substantial socks.


Since circulation to hands and feet is reduced to prevent further loss of heat from the body in general, it is important to avoid overall heat loss.  Dress warmly in general and wear a substantial hat, since a great deal f heat is lost from the head and face.


Avoid smoking and caffeine as these reduce blood flow to the extremities.


Report these symptoms to your physician since some of your medications may contribute to the problem and your physician may want to reevaluate them.

The treatment for serious Raynaud phenomenon is more complex.


Of course, the common sense solutions still apply.  It is always good sense to avoid cold exposure, dress warmly, and stop smoking.


But now, you need to have your physician evaluate you.  First, you may have one of the aforementioned underlying diseases that can cause Raynaud phenomenon.  These diseases may require treatment in themselves; and, the Raynaud may not improve unless the underlying problem is addressed. Second, your physician may be able to offer medical treatment that makes the phenomenon less troublesome.


Finally, if the problem is an emergency, you need to go to the hospital emergency room.  Conditions such as frostbite, thromboangitis obliterans, and arterial embolus require serious intervention, or even surgery, to prevent possible loss of fingers, toes, or an extremity.


So Now You Know

Now you understand some of the mechanisms behind cold hands and when this phenomenon is exaggerated.  You know that if this problem bothers you, avoid cold, dress warmly including mittens and a substantial hat, and avoid caffeine.  And, you now have one more good reason to stop smoking!  If the phenomenon is particularly troublesome, consult your physician.  If the white or blue discoloration does not rapidly reverse or is accompanied by pain or numbness, visit the hospital emergency room.  Armed with this knowledge, you should get more enjoyment from the colder months.


Thomas Falasca, DO              




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