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Q: I am getting more sensitive to colder weather. I am worried about the times my fingers get cold enough to hurt and throb. What are some of the possible causes?

A: A likely possibility is Raynaud’s phenomenon. People with this condition have blood vessels that respond in an exaggerated way to cold. This occurs in their fingers and toes and sometimes in other parts of the body.

Instead of the blood vessels constricting normally in reaction to the cold, they “overreact” and constrict more severely. This causes discomfort.

A key feature of Raynaud’s phenomenon is reversible color changes in the fingers. Initially, the fingers may appear white, but within minutes will turn blue and then red before returning to normal.

Raynaud’s phenomenon may accompany other conditions such as lupus and scleroderma. However, these conditions are relatively rare while Raynaud’s phenomenon without another condition (such as lupus) is common.

Other potential explanations include:

Poor circulation. Atherosclerosis can affect blood vessels anywhere in the body, but it’s rare that it primarily affects the hands

A congenital circulation problem. Some people are born with small or missing arteries in the hands, so their fingers may get less than normal blood flow.

Thyroid disease. An underactive thyroid (hypothyroidism) may cause cold intolerance, though this is usually body-wide, not just in the fingers.

Drugs. Prescription, over-the-counter and recreational drugs may provoke Raynaud’s phenomenon. Examples include beta-blockers (such as metoprolol/Lopressor), pseudoephedrine (as in Sudafed), and cocaine. Caffeine and nicotine may also constrict small arteries in the fingers.

Diseases that cause sluggish blood flow. These can include polycythemia vera, cold agglutinin disease or cryoglobulinemia. Among all people complaining of cold hands, however, these are rarely to blame.

See your doctor for an evaluation. It may be worthwhile to have your thyroid checked, your medications reviewed, and to have some basic blood tests (to look for some of the conditions mentioned earlier in this article).

In the meantime, keep warm. Wear a hat, coat, scarf and gloves before going out in the cold. Hand warmers are another effective remedy for cold fingers.

However, if you have Raynaud’s phenomenon and these actions don’t help, medications (such as nifedipine/Procardia) to open up the arteries of the fingers may be helpful.

Robert H. Shmerling, M.D., is a senior faculty editor at Harvard Health Publishing and corresponding member of the Faculty of Medicine, Harvard Medical School. For additional consumer health information, visit health.harvard.edu.

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