What Is Raynaud's Phenomenon?
Raynaud's phenomenon is a disorder characterized by blood vessel abnormality caused by overactivity of smooth muscle in the wall of arteries, leading to spasms (vasospasms with narrowing) of the small vessels that supply blood to the arms, legs, hands, feet, and sometimes the ears and nose. The typical features of Raynaud's phenomenon include changes in the color of skin from pale to bluish to red, which typically occur after exposure to cold temperatures. Raynaud's phenomenon is usually diagnosed in people younger than 40 years of age and occurs five times more frequently in women than in men. The disorder is sometimes referred to as "white fingers disease."
What Is the Cause of Raynaud's Phenomenon?
The classification of Raynaud's phenomenon is usually separated in two categories: idiopathic or primary Raynaud's phenomenon, when no associated disease is identified, and Raynaud's phenomenon secondary to other diseases (usually autoimmune).
- Factors that can bring on Raynaud's phenomenon (all vasoconstrictive influences), include the following:
- Exposure to cold or hot environments
- Mental stressors
- Certain occupations (vibration from tools, like jackhammers)
- Smoking (nicotine is a stimulant/vasoconstrictor)
- Chemical exposure (such as vinyl chloride)
- Diseases causing Raynaud's phenomenon
- Collagen vascular diseases: Seventy percent of patients with scleroderma (systemic sclerosis) develop Raynaud's phenomenon. Other disorders associated with Raynaud's phenomenon include systemic lupus erythematosus, Sjögren's syndrome, rheumatoid arthritis, mixed connective tissue disease, or dermatomyositis/polymyositis.
- Arterial diseases, including atherosclerosis, thromboangiitis obliterans, or Buerger's disease, involving the small arteries and veins of the hands and feet also have an association with Raynaud's phenomenon.
- Neurologic disorders: Thoracic outlet syndrome, with compression of nerves as they course through the neck and shoulder area, carpal tunnel syndrome, and occasionally stroke, intervertebral disk disease, and spinal cord tumors may produce Raynaud's phenomenon.
- Blood disorders that cause the blood to thicken or turn to sludge (polycythemia).
- Miscellaneous disorders such as hypothyroidism
- Medications that may cause or worsen Raynaud's phenomenon
What Are Raynaud's Phenomenon Risk Factors?
Some people are more likely to develop Raynaud's phenomenon compared to others. Risk factors that have been identified include the following:
- Gender: Primary Raynaud's phenomenon is more common in women than men.
- Raynaud's phenomenon may occur at any age but is most common between the ages 15-35.
- The disorder is more common in populations of people who reside in cooler climates.
- If someone in the family has Raynaud's phenomenon, then there is an increased risk of a family member developing the disorder. Approximately one-third of Raynaud's phenomenon occurs in first-degree relatives.
When Should Someone Seek Medical Care for Raynaud's Phenomenon?
Attacks of Raynaud's phenomenon may be harmless and resolve on their own, especially if you have reversible causes and no underlying serious internal disease. However, your doctor may suggest ways to manage and treat the disease.
Call your doctor in the following instances:
- Your extremities remain cool or discolored, despite rewarming.
- There is an increasing frequency and severity of attacks despite prevention techniques.
- You need help to quit smoking.
- Ulcers develop over the fingertips or toe tips.
- Pain is unrelenting.
If you have continuing discoloration of the fingertips or on parts of your arms or legs, or if it appears that skin breakdown or ulcerations may be present, prompt medical evaluation is needed.
What Are Symptoms and Signs of Raynaud's Phenomenon?
When someone has an attack of Raynaud's phenomenon, the small arteries of the arms and legs go into spasm or become narrow, which limits blood flow to the distal organs. The tissues become deprived of the blood's oxygen, which causes color changes in the skin. However, it should be understood that Raynaud's phenomenon is not the same as frostbite.
- At first, the skin blanches, turning very white, then becomes blue as the oxygen in the involved tissue lowers. As the blood flow improves, the skin often becomes red and will throb. These classic three color changes are not seen in all people, and the order of the color change may also vary. The affected individual will also report numbness in the fingers and occasional pain. The affected skin feels very cold. The areas suffering from lack of oxygen are very well demarcated, usually occurring at joint lines.
- Changes usually occur in the fingers. Blanching may occur in only one or two fingers, but it is not uncommon to see changes in all fingers. In addition, it may affect the toes, tip of the nose, nipples, lips, or even the earlobes. Raynaud's phenomenon is almost always bilateral but occasionally may only affect one hand.
- After the arteries relax again, the tissues receive more oxygen. Skin color changes from blue to a bright red color. The color change from white to blue to red is called a triphasic reaction. These color changes are essential information for your doctor to make the diagnosis.
The Raynaud's phenomenon attack usually lasts a few minutes, although sometimes it may last several hours.
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What Specialists Treat Raynaud's Phenomenon?
Raynaud's phenomenon is treated by a number of health-care professionals. Often, the diagnosis is made by the primary-care physician or a rheumatologist. Sometimes, the diagnosis may also be made by a dermatologist (skin doctor) or a vascular surgeon. When the disease is stable, the majority of patients follow up with their primary-care physician. Those who have flare-ups with ulcers of the fingertips may need to be seen by a vascular surgeon for removing the dead tissues. Vascular surgeons and rheumatologists also play an active role when deciding on medication treatment.
How Does a Doctor Diagnose Raynaud's Phenomenon?
Attacks of Raynaud's phenomenon are usually temporary. A doctor relies on your medical history to make a diagnosis of Raynaud's phenomenon. Unfortunately, there is no single laboratory test to make a diagnosis of Raynaud's phenomenon. If the doctor suspects that you may have Raynaud's phenomenon caused by a specific disease, he or she may take X-rays of your cervical spine and perform blood tests to check for antinuclear antibodies, rheumatoid factor, cryoglobulins, and serum protein electrophoreses. Occasionally, a doctor may perform angiography (injected dye) to determine the type and location of disease in the blood vessels.
Are There Home Remedies for Raynaud's Phenomenon?
Prevention is the best treatment.
- Avoid exposure to cold environments if possible.
- Wear warm clothing over hands, feet, and the entire body.
- Wear loose-fitting clothing in layers.
- Avoid prolonged vibration to fingers.
- Stop smoking or never start.
- Learn methods to control stress.
- Avoiding drinking too many caffeine-containing beverages.
- If you already have Raynaud's phenomenon, take care of your feet and guard them against injury. Avoid walking barefoot, and do not wear tight garments or socks that limit blood flow to the hands and feet.
What Are Treatment Options for Raynaud's Phenomenon?
Treatment is primarily aimed toward education and prevention. Information about avoiding cold or stress may be given, as well as more information about how to stop smoking. However, in some cases, the disease may progress to the point where medication may be required to help relieve symptoms.
What Medications Treat Raynaud's Phenomenon?
Medications that widen blood vessels (vasodilators) help relax and widen the walls of the arteries; this can increase blood to the hands and feet. The following drugs have been used when an inadequate response to preventive treatment occurs. The calcium channel blockers, in particular nifedipine (Adalat, Procardia XL), are the most widely studied drugs for Raynaud's phenomenon and are considered to be the drug of choice if drug treatment is warranted.
- Calcium channel blockers, such as nifedipine, amlodipine (Norvasc), diltiazem (Cardizem CD), or verapamil (Calan), may be prescribed.
- In acute situations in a patient with severe finger pain and bluish fingers, one may apply nitroglycerin gel (the same paste that is used for angina). The effects are immediate, and most patients are relieved of the attack. Unfortunately, not all patients respond to nitrates.
- Sympathetic nervous system inhibitors may be prescribed, such as prazosin (Minipress); older sympathetic nervous system inhibitors, such as guanethidine (Ismelin), reserpine, or phenoxybenzamine (Dibenzyline), have been used but have side effects that many people are unable to tolerate.
- Prostaglandin E has vasodilator action when administered intravenously and has had some success in treating acute Raynaud's phenomenon; one example is PGE1 (alprostadil [Prostin VR]).
- Investigational drugs
- Serotonin S2 antagonists such as ketanserin (Sufrexal) is currently investigational in the United States.
- Nitric oxide donors are one type of treatment being investigated for peripheral vascular disorders, including Raynaud's phenomenon.
- Miscellaneous drugs with unproven efficacy include the following:
When Is Surgery Appropriate for Raynaud's Phenomenon?
Surgery is rarely offered as a treatment for Raynaud's phenomenon. When symptoms cannot be managed and medications are inadequate or have too many side effects, surgical sympathectomy may be offered. This is a rare procedure and is almost never done, since the sympathetic discharge is already at its maximum. Surgical sympathectomy was done in the past with almost no benefit. If the tip of the toe or fingertip is necrotic or gangrenous, debridement (cleaning dead tissue) or amputation may be required, but this is not common.
A more localized form of sympathectomy for the hand, a digital sympathectomy, can be performed by interrupting the nerves of the palm of the hand to restore circulation to the fingers.
Are There Alternative Medicine Treatments for Raynaud's Phenomenon?
Many alternative care products and health supplements are sold for the treatment of Raynaud's phenomenon. Some alternative care practitioners recommend fish oil, gingko biloba, and biofeedback therapy. Unfortunately, there are no clinical studies to validate the claims made by the manufacturers of these therapies. It is best to speak to your doctor before you start with any of these therapies.
Can One Prevent Raynaud's Phenomenon?
Preventing the arteries from narrowing is the key to living successfully with Raynaud's phenomenon.
- Avoid cold weather. Dress in warm, loose-fitted layers of clothing.
- If you smoke, work with your doctor to try to stop the habit.
- Try to identify and lower stressors in your life that worsen the symptoms.
- Remain active and exercise regularly because this also improves blood flow to the hands and feet.
- Do not smoke.
- If you have diabetes, make sure your blood sugars are well controlled. Unregulated high sugars often lead to further blood vessel damage (peripheral vascular disease), which can make symptoms of Raynaud's phenomenon worse.
What Are Complications of Raynaud's Phenomenon?
Uncommonly, Raynaud's phenomenon is recurrent, and the episodes are prolonged enough to cause ulceration and tissue loss on the finger and toe tips. In people who continue to smoke or have Buerger's disease, frank gangrene of the toes and fingers is a real possibility. In some cases, there may be persistent pain and paleness of the digits. Infections are rare but can occur in people who also have diabetes. When complications occur, there is often more workup required to rule out the presence of vasculitis (disease of blood vessels), blood clots, or atherosclerosis.
What Is the Prognosis of Raynaud's Phenomenon?
Raynaud's phenomenon is not life-threatening, but one still needs a thorough, complete exam by the doctor to exclude any secondary causes that may be responsible for it. The symptoms of Raynaud's phenomenon usually go away when the person has moved to a warm environment or has eliminated the stressors that brought on the symptoms.
In those with persistent risk factors, like smoking and exposure to the cold, complications can develop. When the arteries remain constricted for prolonged periods of time, ulceration of the fingertips may occur. This typically complicates scleroderma, with additional thinning and tightening of the skin. To prevent complications, it is vital that patients with Raynaud's phenomenon avoid all situations that trigger the attacks. The hands and feet should always be insulated from the cold.
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Raynaud's Phenomenon Picture
Photo of Raynaud's phenomenon