Circulatory disorders due to exposure to cold

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As soon as it's cold outside, fingers can freeze easily, turn pale and may even feel numb or ache. Although these symptoms are usually harmless, they may be caused by Raynaud's disease, a vascular disorder that affects between 3% and 16% of the population, with women being five to ten times more likely to be affected.

The thermometer on snow shows low temperatures in Celsius or Farenheit.

shutterstock.com / Marian Weyo

Raynaud's syndrome defined:

Raynaud's disease, or Raynaud's syndrome, is a disorder of the human blood vessels, which can be caused by so-called vasospasms (i.e., vascular spasms). These occur paroxysmally (i.e., in fits and starts) in most cases in the fingers, less frequently in the toes or other parts of the body. These cramps reduce the blood supply to the affected parts of the body, which consequently become pale and cold. This is why the syndrome is also called cadaver finger or white finger disease. The triggers can be lower temperatures (below 10°C) in combination with humidity or also psychological strain such as stress. The disease, described in 1862 and named after its discoverer Maurice Raynaud, is nowadays differentiated into two forms. In primary Raynaud's syndrome, the cause is unknown. The second form - secondary Raynaud's syndrome - occurs in the context of other diseases. This could be the case, for example, with scleroderma (i.e. connective tissue disease), after injuries or drug overdoses. The first symptoms of primary Raynaud's syndrome become apparent between the ages of 14 and 40, and women are affected about five times more often than men. In the male population, the condition appears later in life.

Three stages of discoloration:

This disease is characterized by whitening of individual fingers (or their parts) or the entire hand. During this process, the arterioles contract due to cold or stress and the blood flow becomes weaker (ischemia). Subsequently, they may turn bluish as a result of a lack of oxygen supply (hypoxia). If the blood supply to the fingers increases again, the blood vessels dilate and a reddish discoloration is visible (reactive hyperemia). Often, not all three phases of discoloration are present, and only whitening of the fingers may be visible. At this stage, the digiti (i.e., fingers) may hurt or they may feel numb. These phases may last from a few minutes to several hours.

Medication measure with calcium antagonists:

If the general measures such as warm gloves or stress reduction are no longer sufficient, there is the possibility to take medication against the syndrome. The most important group of drugs are so-called calcium antagonists (i.e. calcium channel blockers), such as nifedipine or nitroglycerine. The latter acts as a vasodilator. However, these drugs may also cause side effects such as swelling of the fingers or headaches. In the case of secondary Raynaud's syndrome caused by narrowed vessels, therapy with acetylsalicylic acid (ASA for short) and a cholesterol-lowering drug (i.e. statin) might also be recommended by the doctor.

Limited therapy:

Calcium channel blockers are the most commonly prescribed medications for individuals with primary Raynaud's syndrome. In this regard, a review published in 2016, in the Cochrane Library scientific database, examined several randomized control trials to observe the effects of different calcium channel blockers on primary Raynaud's syndrome. It used attack rates, severity scores, participant preference scores, and physiologic measures to evaluate 296 participants from seven trials. Four studies evaluated nifedipine and the remaining three evaluated nicardipine. Comparisons were made with placebo in six studies and with both placebo and dazoxibene (i.e. active ingredient used in Raynaud's patients) in the last. The Cochrane review showed a minimal effect on the frequency of attacks. Although small, the review found qualitative evidence that there was an effect on the severity of attacks.

Conclusion:

While the primary concern with secondary Raynaud's syndrome is to treat the underlying condition, it is important to note that not every person who has cold hands or feet more often has the condition. Other causes such as low blood pressure could possibly be a reason. As always, if you have any suspicions, see a professional such as a doctor for advice.


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References:

Katrin M., Hilke N., Prof. Sebastian S. DGA guidebook: the circulatory disorder - Raynaud phenomenon. Deutsche Gesellschaft für Angiologie - Gesellschaft für Gefäßmedizin e. V. Germany. 2011.

Ennis H, Hughes M, Anderson ME, Wilkinson J, Herrick AL. Calcium channel blockers for primary Raynaud's phenomenon. Cochrane Database of Systematic Reviews 2016, Issue 2. art. No: CD002069. DOI: 10.1002/14651858.CD002069.pub5.

https://www.pharmazeutische-zeitung.de/gefaesskraempfe-bei-kaelte-122248/seite/alle/

http://www.meduniwien.ac.at/typo3/index.php?id=199

https://www.netdoktor.de/krankheiten/raynaud-syndrom/

https://emedicine.medscape.com/article/331197-overview

https://docksci.com/raynauds-phenomenon-and-other-circulatory-disorders-of-the-fingers_5afcc44ad64ab20631711403.html

Author

Danilo Glisic

Last Update

22.02.2021

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