What Causes Attacks of Raynaud Phenomenon?

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Question: What Causes Attacks of Raynaud Phenomenon?

My sister has Raynaud phenomenon, and my mother makes me do all the grocery shopping because my sister says walking down the freezer aisle may trigger an attack. But at the same time, my sister likes to ski, and I've seen her spend a whole day on the slopes without any problem. What's up with that? Is she just faking it so I'll have to do all the grocery shopping?

--John from Ohio

Answer: Obviously, John, I am not qualified to offer any judgment on your family's psychodynamics, or on who may or may not be faking what medical condition in order to avoid which household chores. Every family is unique in this regard, and in general solutions have to be improvised.

What I can tell you is that your sister's claims are consistent with the condition known as Raynaud phenomenon.

Raynaud phenomenon is a medical condition in which the blood vessels in tips of the fingers and sometimes the toes are overreactive (usually for unknown reasons), and as a consequence they constrict abnormally when the victim is exposed to cold temperatures, or sudden emotional stress. This abnormal constriction of the blood vessels causes dramatic color changes in the affected digits (with the fingertips turning deadly white, or purplish-blue, or deep red, or a succession from one of these color changes to another), accompanied by numbness, tingling and sometimes pain.

Raynaud phenomenon can be a relatively mild condition, or quite severe, leading to actual tissue destruction in the tips of the fingers or toes. It can usually be controlled by taking preventive measures, or sometimes with medication.

Your question has to do with the kinds of things that can trigger an attack of Raynaud phenomenon.
How can it be that spending an entire day out in the cold can be just fine, but walking down the freezer aisle can be a problem? Here is what UpToDate, an electronic reference for doctors and patients, has to say about the things that can trigger attacks of Raynaud phenomenon:
"A Raynaud phenomenon attack can be triggered by exposure to cold temperature or even by a shift in temperature from warm to cool. As a result, even mildly cold exposures, such as those caused by air-conditioning or by the cold of the refrigerated food section in a grocery store, can cause an attack. Experiencing a general body chill can also trigger an attack, even if the hands and feet are kept warm. Feeling emotional stress and being startled can cause an attack of Raynaud phenomenon due to the release of nerve transmitter substances; these substances activate the alpha receptors on the muscle of the blood vessel, which signal the blood vessels to narrow."
In other words, while cold temperatures themselves can trigger an attack, a mere shift in temperature from warm to cool can also do it.
It is entirely possible, therefore, that your sister may be able to avoid an attack while out on the slopes by wearing warm clothing and heated gloves -- but that the sudden change in temperature when she turns down the freezer aisle may trigger an attack.

The bottom line is that medical science cannot disprove your sister's claims regarding the triggers of her Raynaud phenomenon. Perhaps you can turn the tables by feigning a grass allergy, so that your sister will have to take over your lawn mowing chores.

Want to learn more? See UpToDate's topic, "Raynaud phenomenon" for additional in-depth medical information.


Wigley, FW. Clinical manifestations and diagnosis of the Raynaud phenomenon. UpToDate. Accessed, June 2012.

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