In a cohort of 245 men with vibration white finger disease, the effects of tobacco use on the symptoms of the disease and the results of a cold provocation test were studied. The tobacco habits of 111 patients were confirmed by measurement of nicotine and cotinine in plasma. In a subgroup the cold provocation test was repeated after nicotine absorption according to individual habits. Patients with advanced disease as measured on a symptom scale were found to use tobacco more often and to have higher cotinine levels than patients with less advanced disease. Pathologic test results were found more frequently among users of tobacco than among nonusers. Habitual use of tobacco seems to aggravate the symptoms of vibration white finger disease and to result in an increased reactivity in a cold provocation test.