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Vascular disease made worse in the cold

Winter is a great time to be a vascular medicine doctor. I don’t know if it is very PC to say this, but cold weather brings out a lot of interesting vascular disease. When exposed to cold, blood vessels in the skin constrict. This results in blood shunting from the skin to the brain and internal organs. This is obviously a normal and positive vascular reaction to cold. However the reality is that cold weather induces many vascular diseases that result form unhealthy reaction of the vessels or their contents with the temperature. Cold induced vascular disease is more common in colder climates. This does not mean it is not seen in temperate regions of the world. In any case, cold induced vascular disease has many faces. It ranges from mild to irritating to severe and potentially limb threatening.

Ice skating in the cold weather

Who said cold exposure can't be fun?

Blue toes and blue fingers

There are many reasons for blue toes. Most are not related to cold at all. Causes for blue toes range from benign to limb threatening. But most cold induced vascular disease results in blue toes. And many reasons for blue toes and blue fingers are actually related to temperature:

  • Raynaud’s phenomena, for instance. Raynaud’s phenomena are more prevalent in cold weather as cold exposure exacerbates the vasospastic disorder.
  • Pernio is a disorder that results in small purple vesicles at the tip of toes and fingers. Pernio is also known as chilblains. It is related to cold and recurrent. This means that it can be seen with every cold season. Pernio is often mistaken for other causes of blue toes.
  • Blue toe or Pernio

    Lesions appearing like Pernio that are actually embolic. Notice the blue mark under the vesicle

  • Frostbite. No discussion of cold induced vascular injury is complete without it. But frostbite is not a vascular disease. It is a generalized tissue disorder. So why would I be discussing frostbite here, together with other vascular disorders? Because frostbite can result in blue toes or blue fingers. It can be mistaken for other causes. If frostbite is not recognized patients may receive wrong treatment and an un-needed evaluation.
  • Blue toes from frostbite

    Blue toes from frostbite

  • Acrocyanosis is another one of those cold induced conditions that have to be mentioned. Acrocyanosis results in blue toes and can be primary or secondary. Acrocyanosis becomes worse with cold exposure and better with re-warming.
  • Acrocyanosis before and after warming

    This is an example of primary acrocyanosis

  • Cryoglobulinemia is a disorder that results in immune complex deposition in cold tissue. Cold tissue is often located in the extremities. When exposed to cold weather the fingers are even colder and the manifestations of cryoglobulinemia are worse.

Are cold feet during cold weather always a sign of vascular disease?

Cold feet are a huge issue during winter. True. In most people that complain about cold feet no cause can be found. Others have one of many known causes for cold feet. In both cases there is one fact that holds true. When the weather gets cold, cold feet become worse off. As vascular medicine doctors, we meet many of these patients who are concerned they may have peripheral artery disease or Raynaud’s phenomena, for instance. Some do. Many don’t.

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