Last week it was chilly in New York City. Typical of January, it was dark when I left my office and temperatures were hovering around freezing. I had unwisely worn a pair of AllBird flats to drive to and from my office (I have never masted driving in heels comfortably). By the time I got to my car several blocks away, my three middle toes were painfully numb. When I took my shoes off at home it looked like those same toes had been dipped in white paint.
I should have anticipated this. I have had Raynaud’s Phenomenon, an exaggerated constriction of the blood vessels in response to cold, for almost 20 years. Raynaud’s is very common, affecting as many as 20% of women and 14% of men. It often presents in the teens or 20s and unsurprisingly more common in colder climates. Most people experience Raynaud’s in the fingers and toes, but the ears and nipples are other commonly affected locations.
The vast majority of people with Raynaud’s don’t have any associated disorders, but a subset of people have secondary Raynaud’s (also called Raynaud’s Disease). The list of associated disorders is long, but hypothyroidism and rheumatologic diseases are among the most common. It may be helpful to check basic labs for these diseases, especially if there is a family history of thyroid or rheumatologic disease.
For the vast majority patients like me, Raynaud’s is an annoyance but is not dangerous. Often wearing warmer clothes (in my case a pair of socks would have gone a long way even if it wouldn’t be so fashionable) and using hand warmers is all that is needed to treat the symptoms.
Some medications that cause vasoconstriction, like over-the-counter decongestants like Sudafed, can exacerbate symptoms. Some physicians recommend quitting caffeinated drinks like coffee to see if it improves symptoms. However, I have never found the symptoms bothersome enough to warrant giving up my caffeine habit.
Raynaud’s in the nipples can be a cause of breastfeeding difficulties. It is always worth mentioning to your physician if you think this may be an issue for you.
In more severe cases, often associated with rheumatologic disease, Raynaud’s can lead to skin ulcers or even gangrene. If wearing warmer clothes and using tools like hand warmers doesn’t control these more severe cases you should talk to your doctor about medications that can be helpful.
Ultimately, most of us who have Raynaud’s know when to expect symptoms to develop and take steps to head them off.
The Endocrinologist Is In 