A 28-year-old man presents to his primary care physician with intermittent episodes of severe numbness and tingling in the fingers of both hands, accompanied by a “pale” appearance of the skin over the past several months. These episodes are sometimes followed by pain in the fingertips. He has no known medical conditions and does not take any medications. He does not drink alcohol, but occasionally smokes cigarettes. His diet consists mostly of fast food. He volunteers that he has been under a lot of stress and has been trying cognitive behavioral therapy. He works in construction and roofing. Vital signs are within normal limits. Physical examination reveals normal appearing hands with intact sensation, strength, and distal pulses. His recent labwork done as a part of an annual examination include complete blood count (CBC), comprehensive metabolic panel (CMP), lipid panel, and HbA1c were within normal limits.
Which of the following is not associated with an increased risk of the most likely diagnosis?
C) Male sex
This patient likely has Raynaud phenomenon which is characterized by recurrent vasospasm of the fingers or toes due to triggers such as cold temperatures and stress. The extremities may become pale, cyanotic, or erythematous during the episodes and may be accompanied by numbness, pain, and/or tingling. There is symmetric bilateral involvement. These episodes are self-limited. It is more common in women than men.
Answer choice A: Exposure to cold weather, is incorrect. Episodes caused by exposure to cold temperature are the most common feature in Raynaud phenomenon.
Answer choice B: Frequent emotional stress, is incorrect. Emotional stress has been identified as a trigger for episodes of Raynaud phenomenon.
Answer choice D: Occupational exposure to various solvents, is incorrect. Various solvents, such as arsenic and poly vinyl chloride, can predispose to Raynaud phenomenon. This form of the disease is known as secondary Raynaud phenomenon.
Answer choice E: Occupational exposure to vibration, is incorrect. Occupational exposure to vibration can cause secondary Raynaud phenomenon. It is most commonly seen in patients around 35 to 40 years of age due to prolonged exposure to power tools and other forms of vibration.
Answer choice F: Smoking cigarettes, is incorrect. Cigarette smoking is associated with Raynaud phenomenon. Nicotine also causes vasoconstriction and can worsen the condition.
Key Learning Point
Raynaud phenomenon is a vasospastic condition characterized by pale extremities after exposure to cold weather or emotional stress. It affects women more often than men.
