Raynaud’s phenomenon

Raynaud’s phenomenon is a condition that affects blood flow to the arms and legs, also called the extremities. It occurs when the blood vessels that feed the fingers and toes get smaller in reaction to cold or emotional stress (this event is called a vasospastic attack). Diverting blood flow away from the hands and feet to keep the body’s core warm is a normal reaction to extreme cold. However, in Raynaud’s phenomenon, the body reduces blood flow to the fingers and toes after relatively minor cold temperature exposures, such as holding a glass of ice water or being in an air-conditioned room. Fingers, toes, hands, feet, lips and the tongue are most commonly affected. They may become painfully cold, tingling or numb and become a ghostly shade of white or blue. The same reaction can be triggered by emotional stress or excitement.

Raynaud’s phenomenon can occur on its own. This is called primary disease. Most people with Raynaud’s have this type. It can occur at any age, but usually begins before age 30. It’s more common in people who live in cold climates. Women are more likely to have primary Raynaud’s.

Secondary Raynaud’s phenomenon is not as common, but it is often more complex and severe. It occurs with other diseases, such as lupus or scleroderma. It may be linked to certain medicines, such as chemotherapy drugs, or the use of vibrating tools, such as jackhammers, which may cause hand or wrist injuries.

The causes of primary Raynaud’s are unknown. However, episodes are often triggered by cold temperatures and sometimes emotional stress – like if you become nervous or excited.

There are many causes of secondary Raynaud’s phenomenon. These include changes to blood vessels or how the body controls blood flow. These changes can happen if you get another disease or become ill. For example, in scleroderma, the skin and finger blood vessels are narrowed by scarring in the blood vessel wall.

The symptoms of Raynaud’s phenomenon can include:

          Extreme sensitivity to cold. The body may react to emotional stress as if it were reacting to cold.

          Skin color changes. Fingers, toes, and/or sometimes the ears, lips and nose turn white due to lack of blood flow (called pallor). The blood that’s left in the tissues loses its oxygen and the affected area turns blue (called cyanosis). As fresh oxygen-rich blood returns to the area, it often turn bright red.

          Coldness, pain and numbness. A lack of oxygenated blood in the fingers triggers these feelings. Numbness is the sensation that the hands fingers have "fallen asleep."

          Warmth, tingling and throbbing. The quick return of blood to the fingers triggers these feelings.

          Skin ulcers and gangrene. For people with severe undiagnosed disease and attacks that last a long time, painful, slow-healing sores may occur in the finger tips. In rare cases, a long-term lack of oxygen to the tissues can result in gangrene (when a body part loses its blood supply).

A primary care doctor can usually determine if a person has Raynaud’s phenomenon by getting a medical history and description of an attack and doing a physical examination. He or she may examine the fingers under magnification to look for abnormal blood vessels in the skin. Sometimes, special blood tests may be needed to distinguish primary from secondary Raynaud’s. These tests look for evidence of an autoimmune or connective tissue disease.

The goal of treatment is to keep episodes from happening and make sure they don’t keep the person from doing everyday activities. In secondary Raynaud’s phenomenon, the goal is to treat the disease responsible for the condition and to prevent ulcers and tissue damage.

For most people with Raynaud’s phenomenon, a conservative approach not using medicines is sufficient to control attacks. For people with more severe attacks, medications may be added.

No drugs are approved by the U.S. Food and Drug Administration for the treatment of Raynaud’s phenomenon. However, many drugs that are approved for high blood pressure or chest pain caused by coronary heart disease are used by doctors to treat Raynaud’s phenomenon, and appear to be effective. The most popular are calcium channel blockers, such as nifedipine, amlodipine and felodipine. Some of these can also help heal skin ulcers on the fingers or toes. Other drugs called alpha-receptor blockers that open blood vessels may be used. To help heal skin ulcers, some doctors prescribe a nonspecific vasodilator (drug that relaxes blood vessels), which is applied to the fingers.

In severe cases that do not respond to other treatment and threaten to damage tissue, a doctor may recommend surgery. Surgical procedures that are used include cutting the nerves that control narrowing of the blood vessels or performing surgery to widen the blood vessels.