Raynaud's Phenomenon

Basics of Raynaud's Phenomenon

Raynaud's (pronounced "ray-NODES") phenomenon refers to episodic color changes in the skin of the fingers and toes during exposure to cold or in response to emotional stress. In some people, the ears lips and nose may also be affected.

Although it is normal for blood flow to the fingers to be reduced in extreme cold people with Raynaud's phenomenon have difficulty on mild days in air-conditioned rooms or when holding a cold drink. Episodes may last for several minutes after the body becomes warm again.

When this condition occurs in the absence of disease it is known as "primary Raynaud's phenomenon." Approximately 10 percent of healthy women have this form. Raynaud's may also occur with diseases in which the blood vessels have been injured or when elements of the blood are sluggish. This form is called "secondary Raynaud's phenomenon" and is a feature of arthritis and related diseases such as scleroderma, lupus, rheumatoid arthritis and others.

Immediate medical attention

In secondary Raynaud's phenomenon sores called ulcers may develop when blood does not flow adequately to the tissues. Examine feet and hands daily to check for ulcers. If an ulcer develops keep it clean and covered and see a doctor right away.

Prognosis

Episodes of Raynaud's phenomenon usually occur only once in a while and typically don't cause permanent damage. Some people however may have frequent and severe episodes.

Without treatment secondary Raynaud's phenomenon can damage the affected part of the body. When blood does not flow adequately to the tissues sores called ulcers may develop. If left untreated these sores can become infected and may take a long time to heal. This kind of damage rarely happens in primary Raynaud's phenomenon. Therefore it is important to find out what type of Raynaud's phenomenon is present so that the proper treatment can be applied to prevent damage.

Pain

Pain may occur during episodes of secondary Raynaud's phenomenon.

Curability

Although there is no cure for Raynaud's phenomenon the condition can be controlled and symptoms can be reduced in most cases.

Incidence

Raynaud's phenomenon can begin at any age but primary Raynaud's phenomenon typically begins during adolescence. If it begins in later years in men or in association with other symptoms the person with Raynaud's phenomenon symptoms should see a physician for medical attention and proper diagnosis.


Prevention

A prevent with primary Raynaud's phenomenon can try to prevent episodes. A person with secondary Raynaud's phenomenon can try to prevent tissue damage. This can be done by protecting the body from cold and avoiding aggravating factors such as excessive emotional stress smoking certain medications like nonselective beta-blockers use of industrial tools with violent vibration and use of narcotics.

Anatomy

During an episode of Raynaud's phenomenon the blood vessels in the affected areas--usually the fingers and/or toes--become narrower for a short time. This narrowing prevents the blood from flowing freely to the affected area.

Symptoms

As the blood flow decreases due to the narrowing of blood vessels the following symptoms may be noted:

  • Change of skin color in the affected area. First the skin may turn white because there is little blood in that area. Then it may turn blue because the blood remains stagnant in the blood vessels due to improper flow. Finally the skin my turn red or purple as blood begins flowing again. Sometimes skin may turn only white or blue.
  • Numbness and/or coldness in the affected area as the blood flow slows. Pain may occur during episodes of secondary Raynaud's.
  • Swelling, tingling, aching, warmth, and/or throbbing in the affected area as the blood begins flowing again.

Episodes of Raynaud's phenomenon usually occur only once in a while and typically don't cause permanent damage. Some people however may have frequent and severe episodes.

Without treatment secondary Raynaud's phenomenon can damage the affected part of the body. When blood does not flow adequately to the tissues sores called ulcers may develop. If left untreated these sores can become infected and may take a long time to heal. This kind of damage rarely happens in primary Raynaud's phenomenon. Therefore it is important to find out what type of Raynaud's phenomenon is present so that the proper treatment can be applied to prevent damage.

Causes

Doctors aren't sure exactly what causes Raynaud's phenomenon. They do know however that episodes are often triggered by cold temperatures and sometimes by emotional stress such as nervousness or excitement. There are many causes of secondary Raynaud's phenomenon including inflammation of the blood vessels (called vasculitis) or blockage of blood vessels.

Diagnosis

To diagnose Raynaud's phenomenon a doctor may:

  • perform a thorough general physical examination and ask questions about symptoms (as already mentioned Raynaud's phenomenon may occur as a symptom of other illnesses)
  • take blood samples to test for other illnesses that may have similar symptoms
  • examine the fingers under a special microscope to look for abnormal blood vessels.
  • follow the patient's health status over the course of several visits.

Treatment

Most people with primary Raynaud's phenomenon don't require medical treatment although many choose to take medication during the winter months. People with secondary Raynaud's phenomenon are at risk for fingertip ulcers and tend to have active symptoms all year long.

The goal of treatment of Raynaud's phenomenon is to prevent episodes and in secondary Raynaud's phenomenon to prevent tissue damage. This can be done by protecting the body from cold and avoiding aggravating factors such as excessive emotional stress smoking certain medications like nonselective beta-blockers use of industrial tools with violent vibration and use of narcotics. In some cases a doctor may prescribe medication.

Self-management

A person with Raynaud's phenomenon can treat or manage their own condition by protecting the body from excessive cold and by protecting the skin.

Cold protection

To avoid episodes a Raynaud's phenomenon the entire body should be warm at all times. Follow these tips to avoid getting too cold:

  • Dress warmly in layers of loose-fitting clothes especially during cold weather and during changes of season.
  • Wear a hat in cold weather because body heat is lost through the scalp. Cover your face and ears with a scarf.
  • Wear loose-fitting boots and shoes that won't cut off the blood circulation.
  • Wear heavy socks or layers of socks.
  • Wear mittens -- they are warmer than gloves.
  • Always keep a sweater or jacket nearby even during the summer. It may be cold enough to need it in air-conditioned buildings.
  • Use flannel sheets or layers of blankets. Use an electric blanket to warm the sheets before getting into bed. If your hands and feet get cold while sleeping wear mittens and socks to bed.
  • Keep the rooms used most often at a comfortable temperature.
  • Start running the bath or shower water well before bathing so you don't touch the cold water. Keep the bathroom door closed so steam will warm the room.
  • Ask family and friends to help. For example, let someone else get the newspaper from outside or start the car on a cold day. Avoid household tasks that require putting hands in cold water.
  • Wear gloves or mittens to reach into the freezer.
  • Use insulated containers gloves or napkins to hold cold drinks or food.
  • Rinse and peel vegetables with warm water.
  • Use chemical heat packs to supplement mittens and warm clothing.

Skin protection

Poor blood flow may make skin dry. It may also cause cuts cracks or sores to heal more slowly than usual. These tips can help protect skin:

  • Use lotion with lanolin on hands and feet every day to keep the skin from chapping or cracking.
  • Wash with a mild creamy soap. Clean between fingers and toes but don't soak them.
  • Examine feet and hands daily to check for ulcers. If a ulcer develops keep it clean and covered. See a doctor right away.
  • Protect fingernails and toenails. Use a lotion to keep the cuticles soft. Don't cut the cuticles with scissors or use sharp instruments to push them back. Instead gently push them back with a cotton swab soaked in cuticle remover. Carefully cut hangnails and file your nails in a rounded fashion to the tips of your fingers.
  • Wear rubber gloves while washing dishes.
  • Take care when doing activities that put pressure on the fingertips such as using a manual typewriter or playing the guitar or piano. This kind of pressure may cause your blood vessels to narrow thus triggering an episode.
  • Wear clothes made of natural fibers such as cotton and wool. These draw moisture away from the skin.

Other tips

  • Don't smoke. Chronic smoking causes blood to narrow. Medications to treat Raynaud's may not be as effective in smokers.
  • Try to avoid emotional stress. Ask a doctor about relaxation techniques and other stress reduction methods.
  • Because certain drugs may cause blood vessels to narrow all the doctors that work with a person with Raynaud's phenomenon should be told about the condition and medications should be discussed. Working in partnership with a doctor may help determine which drugs and treatment are most suitable for each person.
  • A warmer climate will not cure Raynaud's phenomenon but it may cut down on the occurrence of episodes and reduce the risk of developing ulcers on fingers. If you consider moving to a warmer climate you'll need to decide if the benefits outweigh the expenses and complications of relocating.
  • Look into biofeedback training. It may help control Raynaud's phenomenon. Biofeedback may also help reduce pain and promote relaxation. A doctor should be able to discuss if it would be helpful and where to find training.

Handling an episode

If an episode a Raynaud's phenomenon occurs stay calm and get your whole body warm by going indoors or by putting on warm clothing. Then follow these steps:

  • Gently warm the fingers and toes as soon as possible. Placing hands under the armpits often helps.
  • Wiggle the fingers and toes. Move or walk around to help blood flow freely.
  • When hands start to feel cold held them above the head. They swing them around as in throwing a softball.
  • Run warm--not hot--water over the fingers or toes until normal skin color returns. Do not use a hot water bottle or heating pad which may damage the skin.

Exercise and therapy

Exercise may have some benefit to people with Raynaud's phenomenon. A doctor may be able to advise if an aerobic exercise program would be helpful.

Medications

No drugs are specifically approved by them U.S. Food and Drug Administration for treatment of Raynaud's. However, many drugs used to treat high blood pressure or angina pectoris have been shown effective and safe in treating Raynaud's phenomenon. These include calcium channel blockers such as nifedipine, amlodipine, isradipine, and others.

Some of these medications may have side effects such as headache, palpitations, lightheadedness, or dizziness or fluid retention. Contact a doctor if questions arise about side effects from medications or questions about their use.

Surgery

In rare cases a doctor may recommend sympathectomy to treat Raynaud's phenomenon. This operation involves cutting the nerves that may be making the narrowing of the blood vessels worse. The procedure is done mainly for secondary Raynaud's phenomenon and usually is not necessary.

Credits

Some of this material may also be available in an Arthritis Foundation brochure.

Adapted by Frederick A. Matsen III M.D. from the pamphlet originally prepared for the Arthritis Foundation by Fredrick M. Wigley M.D. Johns Hopkins University Baltimore; Susan J. Effertz M.D. Great Falls Clinic Great Falls MT; James R. Seibold M.D. University of Medicine and Dentistry of New Jersey New Brunswick NJ; and Laura Robbins DSW Hospital for Special Surgery NY. This material is protected by copyright.