Some people get goosebumps when they’re cold. Others get white and purple fingers! This is because of Raynaud’s (Ray-NOSE) phenomenon, which is a condition where small blood vessels in the fingers and toes overreact to the cold or to stress, making them spasm and temporarily reduce blood flow. This causes a distinct color change, ranging from white to a purpley-blue, then back to their original color as temperatures rise and stresses subside. This could cause discomfort, such as a tingle or numbness, but usually your toes will just feel cold.   This phenomenon affects up to 5% of the population, mostly women under 30.

Let’s talk about the two types: Primary and Secondary. Primary Raynaud’s is the milder, more common form, and it is not linked to another disease. It often affects young women and can be managed with lifestyle changes. Secondary Raynaud’s is caused by an underlying condition, like lupus, rheumatoid arthritis, or scleroderma (hardening of the skin and connective tissues). This case is usually more severe and may cause ulcers or tissue damage if untreated.

What causes it? Well, the blood vessels in the skin are controlled by the sympathetic nervous system, which can over-constrict in response to cold or stress. In Raynaud’s, this vasospasm is exaggerated: the vessels clamp down too tightly or thicken up to cut off circulation. Overactive ‘fight-or-flight’ nerves play a part, sending overly strong messages to constrict your vessels. 

In addition, the endothelium, the inner lining of blood vessels, could fail to function properly and wouldn’t release enough relaxing chemicals like nitric oxide, which normally tells the vessels to open back up. This miscommunication results in an overreaction to a small chill or stressor. If dealing with secondary Raynaud’s, autoimmune damage to vessel walls or thickening of connective tissues only worsens these issues.

If you are experiencing this phenomenon, here are some common triggers to avoid. The first one is cold exposure. Simply reaching into a freezer can trigger Raynaud’s and cause discomfort. Make sure to wear hand and foot protection and keep your fingers warm! Additionally, emotional and physical stress, like smoking, caffeine, and certain drugs (like beta blockers or migraine medicine), could make your toes go white and numb. Repetitive hand motion or vibration exposure, such as activities like typing or handling power tools, will activate this phenomenon as well. Because it is a heritable syndrome, one of the most tell-tale signs is having a close family history of Raynaud’s.

If one is looking for a diagnosis, doctors may perform a nailfold capillaroscopy –meaning they look at capillaries under the fingernails to distinguish between primary and secondary forms after a diagnosis of Raynaud’s phenomenon. Furthermore, blood tests can detect autoimmune markers if a systemic disease is suspected. Keeping hands and feet warm, managing stress, avoiding smoking, and using gloves when handling anything cold can keep your hands and feet warm and colorful.

There is no known cure, but there are a few medications known to mitigate the effects. These include calcium channel blockers to relax vessels, vasodilators or topical nitrates for more severe cases, and Botox injections or other nerve blockers for more resistant cases. For secondary Raynaud’s, treating the underlying autoimmune disease is of priority. 

Why does a little tingle and a color change matter? Even though it is mild, it impacts the quality of life, especially for people in cold climates or outdoor jobs. Personally, I always struggled with living in Utah because my toes and fingers were constantly cold at school, work, sports like skiing, etc. It is difficult to avoid so many triggers, and I would constantly experience the feeling of pins and needles in my fingers. Awareness like this can help people recognize early signs and seek care before more complications develop. Some steps that I have found helpful are using hand warmers, managing my stress, and moving to Los Angeles, California! 

Do not fret. Current research is exploring novel therapies (i.e., fat grafting) and nerve-modulating therapies to restore healthy vessel function. Scientists are even studying biomarkers to predict who might progress from primary to secondary Raynaud’s. All in all, the ultimate goal is to find personalized care that targets the underlying mechanism, not just the symptoms. Let’s hope that they don’t give up and get “cold feet!”