Kristen Tekin
PA-C Medcor Provider

There’s a chill in the air that nips at the nose and fingers. If the cold causes your fingers to blanche or become numb, there are a couple of conditions with which you should become well-acquainted. Those changes in your digits may be a problem with blood vessel spasms known as Raynaud’s Disease, or they may indicate a cold exposure injury leading to frostbite. So which is which?

Raynaud’s

The colloquial term “Raynaud’s” (ray-NOSE) is short for Raynaud’s Phenomenon or Raynaud’s Disease or Syndrome. As many as one in ten people have Raynaud’s. There are two types of Raynaud’s: “Primary Raynaud’s” and “Secondary Raynaud’s.”

Primary Raynaud’s can occur at any age, but most commonly begins between the ages of 15–25 years.Women are more commonly affected than men. The cause of primary Raynaud’s is unknown. Raynaud’s-related blood vessel spasms are an overreaction of the arteries to cold, vibration, moisture, or occasionally to emotional stress. Essentially, when a person with Raynaud’s is exposed to cold, their finger vessels clamp down and do not allow the normal amount of blood supply to flow to the fingers. The fingers turn white or blue when the blood supply to the surface skin constricts, or narrows. When a Raynaud’s attack ends, blood flow returns, but may cause redness and discomfort such as tingling or throbbing. Sometimes, this is accompanied by actual pain. Common triggers include holding a cold glass or not wearing gloves or mittens during cold weather. Even milder temperatures can cause an episode, such as any exposures to temperatures lower than 60°F.

A more serious form of the disorder is called secondary Raynaud’s, which can be caused by connective tissue disorders, medications, or injuries. If Raynaud’s symptoms occur after age 35, you may be tested for an underlying disease. Medical conditions that may cause secondary Raynaud’s include:

  • Lupus
  • Rheumatoid Arthritis
  • Scleroderma
  • Sjogren’s Syndrome
  • Carpal Tunnel Syndrome

How to address Raynaud’s

Primary Raynaud’s can often be treated with lifestyle changes alone. Because this form of the disease is less likely to become painful or frequent, your doctor may recommend the following measures as a first step:

  • Limit repetitive hand movements like typing or playing piano.
  • Limit use of vibrating tools, like drills.
  • Increase physical activity.
  • Stop smoking.
  • Wear warm clothes when outside in cool or cold weather and protect your fingers and toes (such as thick or double mittens, socks, boots, chemical hand warmers).
  • Wear socks indoors. Wear oven mitts, mittens, or gloves when taking food out of the fridge or freezer. Drink out of insulated cups.
  • Avoid exposure to low-temperature air conditioning.
  • Run your car heater for a few minutes before driving in cold weather.
  • Soak hands/feet in warm water as soon as symptoms start.

In more severe forms of Raynaud’s, certain prescriptions have shown to decrease the number or severity of episodes. These medications may include prescription pills or skin creams. Rare, serious forms of Raynaud’s may call for surgery or injections. There are no over-the-counter solutions that have proven effectiveness against Raynaud’s.

Frostbite

Frostbite happens when skin cells freeze, which can kill those cells and may cause permanent damage to underlying tissue. Hypothermia, which is also a medical emergency, further increases risk of frostbite because blood circulation decreases to the limbs in order to preserve the core body circulation and heat. Levels of injury occur in stages:

  1. Frostnip (First Degree)—Cold skin and numbness. Symptoms may not be felt at all until rewarming causes painful effects from renewed circulation to the skin. The skin may appear red before turning pale. Skin damage is temporary with prompt rewarming. Skin damage may include chilblains (small red bumps) after a day or two.
  2. Superficial Frostbite (Second Degree)—Ice crystals form in the skin cells. Affected fingers or toes may sting or swell while the injury occurs. After rewarming, patches of blue or purple skin appear that feel sore like a bruise, or skin looks sunburned with peeling. Fluid-filled blisters often occur after a day or two.
  3. Deep (Severe) Frostbite (Third and Fourth Degree)—Lower layers of skin or muscle freeze. The area becomes completely numb and stiffened. As frozen skin and tissue recover, the layers of dead tissue usually blacken and require surgical removal for healing.

Frostbite at any stage requires immediate action to avoid permanent damage like amputation or infection. Rewarming should always be done with warm water, never hot water nor dry heat (such as over a fire or with a heating pad). Frostbite can happen when temperatures are in the single digits Fahrenheit but can also occur with cold water exposure or when skin is pressed against cold metal. Frostbite can take hold quickly in subzero temperatures; for example, it takes 30 minutes or less to get frostbite at a wind chill of -15°F (-26°C).The best way to prevent frostbite is to make sure parts of the body most easily affected by frostbite (nose, ears, toes, cheeks, chin, fingers) are properly covered with dry, warm clothing when outside in cold weather. 

Discerning Frostbite from Raynaud’s

While both frostbite and Raynaud’s cause a change in the appearance of the skin related to cold exposure, there are important differences to recognize. But first, a few words of precaution: these conditions are not mutually exclusive. You may have one or the other… or both. If you have already been diagnosed with Raynaud’s, you are at increased risk for developing frostbite. The impairment of normal blood flow to the fingers and toes increases vulnerability to a cold-exposure injury like frostbite. Similarly, if you have suffered from frostbite, you may have developed Raynaud’s as a consequence of the cold injury.

Another feature to keep in mind is the importance of seeking medical treatment if you think either of these conditions are occurring. There are rare but severe forms of secondary Raynaud’s Phenomenon that are virtually indistinguishable from frostbite and may require an equal level of medical attention to treat.

Areas affected by Raynaud’s and frostbite differ: while Raynaud’s generally affects fingers and toes, frostbite frequently also involves cheeks, chin, or ears. Other differences in these two conditions include:

  1. Skin changes due to Raynaud’s are generally more sudden as compared with gradual changes due to frostbite injury. For this reason, frostbite is more often associated with a prolonged extreme cold exposure, while Raynaud’s is associated with shorter, less severe cold exposure.
  2. Raynaud’s is far less likely than frostbite to cause any permanent skin or muscle/nerve damage.
  3. Raynaud’s is unlikely to continue to show visibly abnormal skin after rewarming, like the blisters, bruises, or mottling of frostbite. Skin discoloration of Raynaud’s, for example, may last hours versus frostbite lasting days. Frostbite is also more likely to show distinct patches or areas of discoloration as opposed to more uniform discoloration related to Raynaud’s.

Work-related Prevention

Sometimes work conditions can make one more vulnerable to frostbite or even to developing Raynaud’s. Take care to keep your extremities warm during prolonged hours in cold weather. You should also limit repetitive movements or use of vibrating tools like jackhammers for extended periods, which have both been associated with secondary Raynaud’s. Certain chemicals, such as vinyl chloride used in the plastics industry, can increase risk of developing secondary Raynaud’s as well. If you experience any symptoms of Raynaud’s or frostbite, do not delay care.

This article is not intended to diagnose or treat any condition or to give medical advice. Always consult your primary care provider for healthcare instructions. External links are provided as references and do not indicate an endorsement by Medcor. External links are subject to other sites’ terms of use and privacy policies.

References

Penn Medicine, “The Cold Truth About Raynaud’s,” December 1, 2017, https://www.pennmedicine.org/updates/blogs/health-and-wellness/2017/december/raynauds

Cleveland Clinic, “Frostbite,” May 21, 2020, https://my.clevelandclinic.org/health/diseases/15439-frostbite

Arthritis Foundation, “Raynaud’s Disease,” https://www.arthritis.org/diseases/raynaud-s-disease

Johns Hopkins Medicine, “Raynaud’s Phenomenon,” https://www.hopkinsmedicine.org/health/conditions-and-diseases/raynauds-phenomenon

Mayo Clinic, “Raynaud’s disease,” November 6, 2020, https://www.mayoclinic.org/diseases-conditions/raynauds-disease/symptoms-causes/syc-20363571

Mohammad Iqbal Khan, Mohammad Tariq, et al., “Efficacy of cervicothoracic sympathectomy versus conservative management in patients suffering from incapacitating Raynaud’s syndrome after frost bite,” Journal of Ayub Medical College 20, no. 2 (2008), https://pubmed.ncbi.nlm.nih.gov/19385450/

Andrew M. Luks, Colin K. Grissom, et al., “Can People with Raynaud’s Phenomenon Travel to

High Altitude?,” Wilderness and Environmental Medicine 20, (2009): 129–138, https://www.wemjournal.org/article/S1080-6032(09)70109-7/pdf

Zsuzsanna McMahan, Julie Paik, “Raynaud’s Mimics,” in Raynaud’s Phenomenon: A Guide to Pathogenesis and Treatment, ed. Fredrick Wigley (New York: Springer, 2015), 163–186. University of California San Francisco, “Raynaud’s Syndrome,” https://surgery.ucsf.edu/conditions–procedures/raynauds-syndrome.aspx