Raynaud's pain and blanching has many causes

ALLEN DOUMA. ALLEN DOUMA spent 12 years in clinical practice. He has written, edited and advised on numerous medical publications.

For many years I've had problems with my fingers turning white and hurting whenever they get cold. Last year when I was breastfeeding, my nipples did the same thing. My pediatrician said that I had something called Raynaud's in my fingers but that the problem with my nipples was my child was latching on too tightly. But it didn't matter how hard she sucked, the same thing happened. What do you think is going on?

W.M., Harwich, Mass.



It sounds as if you may have Raynaud's, a condition in which small arteries go into spasm and prevent adequate blood flow. This causes the characteristic blanching and pain. Most commonly affected are the digits, and fingers are involved more often than toes. But Raynaud's can occur in the nipples as well. This usually happens during breastfeeding because of greater exposure and because the evaporation of moisture from the nipples causes cooling.

Raynaud's primarily occurs in young women. In men it is often the result of occupational trauma.

When the condition is related to another disorder, it is called Raynaud's phenomenon. This is the most common form. When no other underlying disease is found it's called Raynaud's disease.

Many medical conditions may cause Raynaud's phenomenon, including scleroderma, rheumatoid arthritis, atherosclerosis, decreased thyroid activity, injury and reaction to certain drugs. In a recent research study, the most common causes of Raynaud's phenomenon were the use of beta-blocker drugs (primarily used for blood pressure control and heart conditions), carpal tunnel syndrome and rheumatoid arthritis.

Episodes of Raynaud's come on quickly and are usually triggered by stress or exposure to cold. Rewarming the affected hands or feet usually restores normal color and sensation within a few minutes, but a burning pain is often felt as the tissue returns to normal.

Do what you can to keep your extremities and nipples warm. Some people with severe Raynaud's wear socks and gloves heated by battery power. Some even decide to move to warmer climates.

Even the slightest change in temperature may be enough to trigger the pain.

Avoid drugs that restrict blood vessels, including tobacco. If stress is a problem (and you certainly may be anxious about the condition of your nipples), you may want to talk to family doctor or a psychological therapist.