Doctor's Notes on Raynaud's Phenomenon
Raynaud's phenomenon (also called Raynaud syndrome) is a disorder in which the body’s blood vessels overreact resulting in over activity of smooth muscle in the wall of arteries, leading to spasms and narrowing of the small vessels that supply blood to the arms, legs, hands, feet, and sometimes the ears and nose.
Symptoms of Raynaud's phenomenon cause color changes in the skin typically after exposure to cold temperatures. At first, the skin blanches (turns very white), then becomes blue as the oxygen in the involved tissue lowers. Blanching may occur in only one or two fingers, but it can occur in all fingers. The affected skin feels very cold. As the blood flow improves, the skin often becomes red and throbbing is felt. The areas suffering from lack of oxygen are well defined, usually occurring at joint lines. Other symptoms of Raynaud's phenomenon include numbness in the fingers and occasional pain. Raynaud may also affect the toes, tip of the nose, nipples, lips, or earlobes. Raynaud's phenomenon attacks usually last a few minutes, but may sometimes last several hours.
Raynaud's Phenomenon Symptoms
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.
Raynaud's Phenomenon Causes
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:
- 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
- These include ergot derivatives, used for migraine headaches (ergotamine), beta-adrenergic blockers, amphetamines or other drugs that constrict (make the blood vessels smaller), and some chemotherapeutic agents (vinblastine, bleomycin).
- Birth control pills are also known to affect circulation.
- Over-the-counter drugs for treatment of the common cold (Sudafed contains pseudoephedrine.)
- Certain cancers, such as lung cancer or pheochromocytoma
Are your feet and toes often cold? Poor blood circulation, known as peripheral arterial disease (PAD), may be the reason. PAD is often the result of an underlying disease, such as high blood pressure, heart disease, diabetes, hypothyroidism, hyper-cholesterol, and anemia. Smoking is also strongly linked to PAD. Peripheral neuropathy may also make your feet feel cold. Common in fair-skinned females, Raynaud's disease makes hands and feet appear blotchy and bluish in cold weather. This may be associated with rheumatoid arthritis, 'Sjögren's disease, or lupus, and is known as Raynaud's phenomenon. Your doctor can check and see if you may have one of these underlying conditions or if you just have cold feet.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.