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Raynaud's Phenomenon

What is Raynaud’s phenomenon?

Raynaud's phenomenon is a disorder that affects the blood vessels in the fingers, toes, ears, and nose. This disorder is characterized by episodic attacks, called vasospastic attacks, that cause the blood vessels in the digits (fingers and toes) to constrict (tighten or close). Raynaud's phenomenon can occur on its own, or it can occur with another condition such as scleroderma or lupus.

Although estimates vary, recent surveys show that Raynaud's phenomenon might affect 5 percent to 10 percent of the general population in the United States. Women are more likely than men to have the disorder. An attack of Raynaud’s is usually triggered by exposure to cold or emotional stress. Along with the fingers and toes, the nose, lips, or ear lobes can also be affected.

Under normal circumstances, when a person is exposed to cold, his or her body's response is to slow the loss of heat. The body does this by causing the blood vessels that control the blood flow to the skin’s surface to move blood from the surface arteries to vessels deeper in the body.

For people who have Raynaud's, however, this normal body response is intensified by contractions of the small blood vessels that supply blood to the fingers and toes. In some cases, this causes the arteries of the fingers and toes to collapse. The result is a greatly decreased supply of blood to the affected body areas, causing skin discoloration.

A person with Raynaud’s phenomenon can experience three phases of skin color changes. Pallor (whiteness) might occur in response to the collapse of the arteries in an affected body part. Cyanosis (blueness) appears because the fingers or toes are not getting enough oxygen-rich blood. Other symptoms that occur during cyanosis are feeling cold and numbness. Rubor (redness) occurs as the blood returns to the affected areas. After an attack is over, throbbing and tingling might occur in the fingers and toes. Attacks of Raynaud’s phenomenon can last from less than a minute to several hours.

Doctors classify Raynaud's phenomenon as either primary or secondary.

Primary Raynaud's phenomenon

Also known as Raynaud’s disease, this form is the more common and the milder of the two types. A person who has primary Raynaud's has no other diseases that might cause Raynaud’s symptoms or associated medical problems. About 75 percent of all cases of primary Raynaud’s phenomenon are diagnosed in women between ages 15 and 40. People with the primary form rarely develop other diseases related with Raynaud’s such as lupus or scleroderma.

Secondary Raynaud's phenomenon

Secondary Raynaud's phenomenon is less common than the primary form; however, it is often a more serious disorder. For patients with a secondary form of Raynaud’s, the disorder is caused by an underlying disease or condition. It is especially common in people with connective tissue diseases. Some of these diseases reduce blood flow to the fingers and toes by causing the blood vessel walls to thicken and the vessels to constrict too easily. Raynaud's phenomenon occurs in about 85 percent to 95 percent of patients with scleroderma, and it is present in about one-third of patients with systemic lupus erythematosus (lupus). Raynaud's also can occur in patients who have other connective tissue diseases, including Sjögren's syndrome, dermatomyositis, and polymyositis.

How is Raynaud's phenomenon diagnosed?

It is often fairly easy to diagnose Raynaud's but more difficult to identify the form of the disorder.

One diagnostic test useful in helping doctors determine the correct form of Raynaud’s is known as nailfold capillaroscopy, during which capillaries are studied under strong magnification. For people with primary Raynaud’s phenomenon, the results of this test will be normal. However, the results are abnormal for those who have the secondary form. During this test, the doctor places a drop of oil on the patient's nailfolds, which is the skin at the base of the fingernail. The doctor then examines the nailfolds under a microscope to look for abnormalities of the capillaries. If the capillaries are enlarged or abnormal, this might indicate that the patient has a connective tissue disease.

Two other tests that the doctor might order to help distinguish between the two forms of Raynaud’s are the antinuclear antibody test (ANA) and the erythrocyte sedimentation rate (ESR).

  • The ANA test determines whether the body is producing special proteins (antibodies) that commonly occur in people who have connective tissue diseases. The test results will be negative for patients with the primary form of the disease, and might be positive for those with the secondary form.
  • The ESR test measures inflammation in the body and tests how fast red blood cells settle out of unclotted blood. Inflammation in the body will cause an elevated ESR. An abnormal reading is an indicator of the secondary form of the disease, whereas a normal reading indicates primary Raynaud’s phenomenon.

How is Raynaud's phenomenon treated?

The aims of treatment are to reduce the number and severity of attacks and to prevent tissue damage and loss in the fingers and toes. Doctors might prescribe medicines for some patients, usually those with secondary Raynaud's phenomenon. However, they most often prescribe non-drug treatments.

Several non-drug treatments can help decrease the severity of a Raynaud's attack as well as promote overall well-being.

Be proactive during an attack

A Raynaud’s attack should not be ignored. By taking the proper steps both the length and the severity of the attack can be decreased. The first and most important action is to warm the hands or feet. In cold weather, people should go indoors. Running warm water over the fingers or toes, or soaking them in a bowl of warm but not hot water will also warm them. Heat causes the vessels to dilate (good) but also increases the tissue’s demand for oxygen (bad). Excessive heat can promote gangrene (very bad). Learning relaxation techniques as well as taking time to relax will further help to end an attack.

Keep warm

Not only is it important to keep your hands and feet warm, but it is also helpful to avoid chilling any other part of the body. In cold weather, people with Raynaud's phenomenon should pay particular attention to the way they dress. Several layers of loose clothing, socks, hats, and gloves or mittens are recommended. Hats are particularly important because a great deal of body heat is lost through the scalp. The feet should be kept dry and warm. Chemical warmers, such as small heating pouches that can be placed in pockets, mittens, boots, or shoes, can give added protection during long periods outdoors. Patients with secondary Raynaud's should talk to their doctors before exercising outdoors in cold weather.

Quit smoking

Nicotine causes the skin temperature to drop, which might lead to an attack.

Learn to control stress

Because stress might trigger an attack, particularly for people who have primary Raynaud's phenomenon, learning to recognize and avoid stressful situations might help control the number of attacks. Many people have found that relaxation or biofeedback training can help decrease the number and the severity of attacks.

Exercise

Many doctors encourage patients who have Raynaud's phenomenon to exercise regularly. Most people find that exercise promotes an overall well-being, increases energy level, helps control weight, and promotes restful sleep. Patients with Raynaud's phenomenon should talk to their doctors before starting an exercise program.

Medicines

People with secondary Raynaud's phenomenon are more likely than those with the primary form to be treated with medicines. Many health care professionals believe that the most effective and safest drugs are calcium-channel blockers, which relax smooth muscles and dilate the small blood vessels. These drugs decrease the frequency and severity of attacks in about two-thirds of patients who have primary or secondary Raynaud's phenomenon. These drugs also can help heal skin ulcers on the fingers or toes.

Other medicines that have helped patients with Raynaud’s include alpha blockers, which counteract norepinephrine, a hormone that constricts blood vessels, and vasodilators (drugs that relax the blood vessels), such as nitroglycerine paste, which is applied to the fingers, to help heal skin ulcers.

It is important to keep in mind that the treatment for Raynaud's phenomenon is not always successful. Often, patients with the secondary form will not respond as well to treatment as those with the primary form of the disorder. Patients might find that one drug works better than another, and some people might experience side effects that require stopping the medicine. For other people, a drug might become less effective over time. Regardless of the medicine a patient is using, it is important to schedule follow-up appointments with the doctor to monitor effects of the medicines.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 12/11/2008…#9849

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