What is Raynaud’s phenomenon?

Raynaud’s phenomenon (RP) is a condition resulting in a particular series of discolorations of the fingers and/or the toes after exposure to changes in temperature (cold or hot) or emotional events. Skin discoloration occurs because an abnormal spasm of the blood vessels causes a diminished blood supply to the local tissues. Initially, the digit(s) involved turn white because of the diminished blood supply. The digit(s) then turn blue because of prolonged lack of oxygen. Finally, the blood vessels reopen, causing a local “flushing” phenomenon, which turns the digit(s) red. This three-phase color sequence (white to blue to red), most often upon exposure to cold temperature, is characteristic of RP.

Raynaud’s phenomenon most frequently affects women, especially in the second, third, or fourth decades of life. People can have Raynaud’s phenomenon alone or as a part of other rheumatic diseases. When it occurs alone, it is referred to as “Raynaud’s disease” or primary Raynaud’s phenomenon. When it accompanies other diseases, it is called secondary Raynaud’s phenomenon.

What causes Raynaud’s phenomenon?

The causes of primary and secondary RP are unknown. Both abnormal nerve control of the blood-vessel diameter and nerve sensitivity to cold exposure have been suspected as being contributing factors. The characteristic color changes of the digits are in part related to initial blood-vessel narrowing due to spasm of the tiny muscles in the wall of the vessels, followed by sudden opening (dilation), as described above. The small arteries of the digits can have microscopic thickness of their inner lining, which also leads to abnormal narrowing of the blood vessels.

What conditions have been associated with Raynaud’s phenomenon?

Raynaud’s phenomenon has been seen with a number of conditions, including rheumatic diseases (scleroderma, rheumatoid arthritis, systemic lupus erythematosus), hormone imbalance (hypothyroidism and carcinoid), trauma (frostbite, vibrating tools), medications (propranolol [Inderal], estrogens without additional progesterone, nicotine, bleomycin [Bleoxane] used in cancer treatment, and ergotamine used for headaches), and even rarely with cancers.

What are the symptoms and signs of Raynaud’s phenomenon?

Symptoms of RP depend on the severity, frequency, and duration of the blood vessel spasm. Most patients with mild disease only notice skin discoloration upon cold exposure. They may also experience mild tingling and numbness of the involved digit(s) that will disappear once the color returns to normal. When the blood-vessel spasms become more sustained, the sensory nerves become irritated by the lack of oxygen and can cause pain in the involved digit(s). Rarely, poor oxygen supply to the tissue can cause the tips of the digits to ulcerate. Ulcerated digits can become infected. With continued lack of oxygen, gangrene of the digits can occur.

Less common areas of the body that can be affected by RP include the nose, ears, and tongue. While these areas rarely develop ulcers, they can be associated with a sensation of numbness and pain.

Patients with secondary RP can also have symptoms related to their underlying diseases. RP is the initial symptom of 70% of patients with scleroderma, a skin and joint disease. Other rheumatic diseases frequently associated with RP include systemic lupus erythematosus, rheumatoid arthritis, and Sjogren’s syndrome.

How is Raynaud’s phenomenon diagnosed?

In patients with the characteristic sequence of skin-color changes of the digits upon cold exposure, diagnosing RP is not difficult. Sometimes, certain patterns in the tiny blood vessels (capillaries) adjacent to the fingernails of patients with RP can be seen using a magnifying viewing instrument. Abnormal nail-fold capillary patterns can suggest the possibility of an associated rheumatic condition. There is, however, no single blood test to help the doctor to confirm the diagnosis. The doctor can order certain blood tests (for example, sedimentation rate, rheumatoid factor, antinuclear antibody, thyroid hormone levels, and protein levels) to exclude associated rheumatic diseases and thyroid disorders. The doctor can also perform certain maneuvers with the patient’s extremities to exclude pinched blood vessels that can produce symptoms that mimic RP, such as in thoracic outlet syndrome.

Typically patients with Raynaud’s phenomenon that is a manifestation of a rheumatic disease have elevated blood sedimentation rates and antinuclear antibodies. Furthermore, capillary nail fold abnormalities can frequently be found as described above.

How is Raynaud’s phenomenon treated?

Management of Raynaud’s phenomenon involves protecting the fingers and the toes from cold, trauma, and infection. Medications that can aggravate blood vessel spasm should be avoided by patients with RP. In patients with persistent symptoms, medications that dilate the blood vessels can be administered.

Patients with Raynaud’s phenomenon who have no symptoms other than the color changes of extremities may require only measures to prevent complications. Prevention measures are important in primary and secondary RP regardless of the severity. Simple initial care involves keeping the body warm, especially the extremities. Warm clothing in colder environments is essential. Cotton gloves can be helpful while searching the freezer. Room temperatures should not be too cool. Rubber gloves protect the hands and prevent cooling while washing dishes. Barefoot walking should be minimized. Compression of the blood vessels by tight-fitting wrist bands, rings, or footwear should be avoided.

Those with RP should guard their hands and feet from direct trauma and wounds. Any wounds or infections should be treated early to prevent more serious infections. Avoiding emotional stresses and tools that vibrate the hand may reduce the frequency of attacks. Biofeedback can also help to decrease the severity and frequency of RP in some patients.

Direct and indirect (passive) smoking should be avoided by patients with RP. The chemicals in tobacco smoke can cause blood-vessel constriction and lead to atherosclerosis (hardening of the arteries), which can further impair oxygen supply to the extremities.

Care of the nails must be done carefully to avoid injuring sensitive toes and fingertips. Ulcers on the tips of the digits should be monitored closely by the doctor. These can become infected. Gently applied finger splints are used to protect ulcerated areas. Ointments that open the blood vessels (nitroglycerin ointment) are sometimes used on the sides of severely affected digits to allow increased blood supply and healing.

Medications that can aggravate symptoms of RP by leading to increased blood-vessel spasm include over-the-counter cold and weight-control preparations, such as pseudoephedrine (Actifed, Chlor-Trimeton, Cotylenol, and Sudafed). Beta blockers, medicines used for high blood pressure and heart disease, can also worsen RP. These include atenolol (Tenormin), metoprolol (Lopressor), nadolol (Corgard), and propranolol.

Patients with persistent or bothersome symptoms may be helped by taking oral medications that open (dilate) blood vessels. These include calcium antagonists, such as diltiazem (Cardizem, Dilacor), nicardipine (Cardene), nifedipine (Procardia), and other medicines used in blood pressure treatment, such as methyldopa (Aldomet) and prazocin (Minipress). Recent research has shown that the blood-pressure drug losartan (Cozaar, Hyzaar) can reduce the severity of episodes of RP possibly more than nifedipine.

Medications that “thin” the blood, such as low doses of aspirin or dipyridamole (Persantine), are sometimes helpful.

Some patients with persistent symptoms can benefit by adding a medication called pentoxifylline (Trental) which makes the red blood cells more pliable, thereby improving circulation.

Severe RP can lead to gangrene and the loss of digits. In rare cases of severe disease, nerve surgery called “sympathectomy” is sometimes considered. In this procedure, to prevent blood-vessel spasm, the nerves that stimulate the constriction of the vessels (sympathetic nerves) are surgically interrupted. Usually, this is performed during an operation that is localized to the sides of the base of the fingers at the hand. Through small incisions the tiny nerves around the blood vessels are stripped away. This procedure is referred to as a digital sympathectomy.

Research

Researchers have reported finding a substantial genetic (inherited) contribution both to the symptoms of RP and to the associated blood-vessel changes of patients with Raynaud’s phenomenon.

Other researchers are studying nitric oxide and its potential relationship to Raynaud’s phenomenon. A gel is being studied which might promote local production of nitric oxide in involved digits. The local nitric oxide, it seems, may open the blood vessels and improve the impaired circulation.

Raynaud’s Phenomenon At A Glance

• Raynaud’s phenomenon is characterized by a pale-blue-red sequence of color changes of the digits, most commonly after exposure to cold.
• Raynaud’s phenomenon occurs because of spasm of blood vessels.
• The cause of Raynaud’s phenomenon is unknown, although abnormal nerve control of blood-vessel diameter and nerve sensitivity to cold are suspected of being involved.
• Symptoms of Raynaud’s phenomenon depend on the severity, frequency, and duration of the blood-vessel spasm.
• There is no blood test for diagnosing Raynaud’s phenomenon.
• Treatment of Raynaud’s phenomenon involves protection of the digits, medications, and avoiding emotional stresses, smoking, cold temperature, and tools that vibrate the hands.

For further information about Raynaud’s phenomenon write to:

The Arthritis Foundation
P.O. Box 19000
Atlanta, Georgia 30326

Raynaud’s Phenomenon – Describe Your Experience
from MedicineNet Discussions

I am 24 and I live in Kentucky. I was diagnosed with Raynaud’s when I was 16, and was told that there was nothing that I could do but live with it and try to stay warm. What people didn’t understand is that it could be nearly 100 degrees F. outside and my fingers and toes would still freeze. It is the most miserable feeling in the world to be cold and in pain all the time and there is nothing you can do about it but sit and wait for it to go away. Luckily, when I got married in September, my insurance changed and I had to find a new doctor. How lucky was it that the provider I chose had written a thesis in college about Raynaud’s phenomenon! She prescribed “Nifedipine” for me and I rarely have any problems anymore. The only side effects that I have found is that my heart races for a few moments after it kicks in and sometimes I get leg cramps. I still have symptoms, but only a few times a week compared to the 10 times a day before I started the medication. My life has almost done a complete 180!
Published: July 08 ::

I was diagnosed with Secondary Raynaud’s Phenomenon three months ago and am still trying all sorts of products to relieve the outbreaks. I have severe outbreaks and can have up to 10 outbreaks a day. Wind, moderate temps, and A/C all contribute to the outbreaks. The greatest relief for me has been a pair of motorcycle gloves I purchased at the BMW motorcycle store. They are about $200 but well worth it. Their meant for motorcycle riders in colder temps. They plug into the car adapter and warm up the hands in about one minute. I haven’t found a pair of gloves yet for outside the car, but my car is my office so it’s been a tremendous help.
Published: July 25 ::

I am a 39 y/o male and was told 4 years ago I have Raynaud’s. In winter my toes turn white and blister like ingrown toenails. When the blood starts to flow through the toes again, my toes feel like they are on fire and very painful until they are normal again. I wear 2 or 3 pairs of socks and wooly shoes at home. If anyone has this and has to work outside like me, I brought some waterproof socks called sealskins and put them over 2 pairs of woolly socks and no matter how hard it rains my feet stay dry and warm. I also take medication over winter which helps a bit but wearing lots of clothing to stop the cold hitting the area is the answer and once I knew what I had, it was easier for me to protect myself and limit the pain.
Published: July 23 ::

I am a 37 year old female and was diagnosed with Raynaud’s syndrome about 4 years ago. In cold weather, my toes and fingers turn completely white and are extremely painful. It feels like pins and needles and severe aching. I can’t even walk until the blood returns to my toes. No one understands how intense the pain actually is. Lately I have been having attacks in the air conditioner. I have also been diagnosed with a connective tissue autoimmune disease, which Raynaud’s can be a symptom of.
Published: July 16 ::

I found out in the last couple of years that Raynaud’s phenomenon has affected my hands and fingers. I play golf, and on mornings when it’s under 50 degrees, the blood circulation in my fingers almost stops completely. I will go four or five holes before the blood flow starts again, which is followed by a stinging sensation in the fingers lasting 15 to 20 minutes.
Published: July 11 ::

This disease is absolutely awful and depressing. I suffer all day. The only time I have relief is minutes after waking up and minutes after lying down and being in a hot bath. The rest of the day I am trapped inside a body that can’t regulate itself. I am constantly irritable. It starts out physiologically with capillary constriction and then turns into mental distress where my extremities look like a walking road map not to mention the discomfort. I can’t stand the fact that there is no treatment. I have tried several vasodilators but they don’t work. I have tried warm clothing but as all of you know as soon as the capillaries open up you become irritably hot and the clothes must come off. I can’t spend my life lying down, in a hot bath and taking clothes on and off.
Published: July 10 ::

I was diagnosed with Raynaud’s about 3 years ago. I dread going outside anymore…even in the spring and autumn…as the slightest breeze sends me into cold spasms. Living in New Zealand has been difficult in the winter as heating is extremely expensive. When I was diagnosed with Raynaud’s, I also had bruise-like markings on my upper leg. The doctor who diagnosed me said it was dry skin. A few months later, the bruises became darker, hard and spread. Turns out I have a disease called morphea that affects 1 in 100,000 people. Nobody is sure what causes it but say they see it in patients who have Raynaud’s.
Published: July 08 ::

My mother was diagnosed with Raynaud’s about two years ago. It has become so bad that her left middle finger was amputated. We live in California, and even in the hot summers she stays up all night with severe pain in her fingers. It’s hard to see my mother cry night over night telling me how much her fingers hurt. Like I mentioned it’s getting worse, her right pinky began turning red then blue and is now in a stage of a charcoal black color. We are seeing a specialist at U.C.L.A who are running tests and doing the best they can.
Published: July 08 ::

I am now 65, living in the UK. I was diagnosed with Raynaud’s disease in my 30s.Both my hands suffered all the described symptoms and I had acute pain. I was given the choice of living with it and risking gangrene and losing my fingers or having two operations to treat it, both sides. This was a cervical sympathectomy which cuts the nerve carrying the cold messages to each hand. I chose that and had the two operations. They were partially successful. My left hand is better than my right. When it’s cold, I get some recurrence but much less than before the operations. I’ve never met anyone else who has the illness or treatment.
Published: July 02 ::

I’m 13, and I have had the condition since I was about 6. It used to happen to only one of my toes. It would turn numb and white. Then a while ago, it started affecting all of my toes and the heels of my feet. The other day I was swimming in pretty cold water and my fingers turned white as well. I have never experienced pain or red and blue coloring, thank goodness. I just have to be careful in the winter and in cold swimming pools.
Published: July 01 ::

My daughter was diagnosed at 4 months of age. The soles of her feet and hands were very dark blue. She is now 5 years old. Some days are hell for her, and she will just sit and cry in pain. She says it feels like pins and needles that never goes away. Winter is worse for her. She drinks green tea and that seems to help. She always wears shoes and at nights she puts her shoes on her bed so her feet don’t have to touch the floor. She is coping well, but now we’re testing for secondary things that can go hand in hand with her Reynaud’s phenomenon.
Published: June 30 ::

Have pinched nerves and nerve root in back with spinal stenosis. Last November both feet became very tender with blister-like sores under toes. Color began changing to purple and red, but I have not noticed the white. Feet, toes and heels very sore and I feel hot even when cold and like standing in a patch of stinging nettles. I am seeing a specialist in July. I would like to know if natural treatment exists.
Published: June 27 ::

I’m a 20 yr old living in Australia, and just recently found out I have Raynaud’s disease. It’s been happening for 6 years now but only recently saw a doctor about it. I get it in my legs so badly I can’t walk or use my legs because there is no blood in them and they go blue. It worsens with cold and tiles and air conditioning. It affects my work because I work in air conditioning running around all day.
Published: June 24 ::

I was diagnosed with Raynaud’s Phenomenon when I was about 18 years old(2000). My first attack was only in my hands, which turned such a dark blue that it was almost black. Since that day I’ve had moderate attacks with cool weather or stressful situations. Unfortunately I’ve been experiencing much more severe symptoms with my Raynaud’s, I’m not sure whether they are related or not. Symptoms during attacks have included: -color change of limbs in cool or hot weather, or under stress -changing pasty white in my face and chest -tingling, cool sensation of lips and digits -warm to burning sensation of ears -distortion to loss of hearing -dizziness (Vertigo) -feeling of sea sickness -cold, very cold
Published: June 24 ::

My lips, nose and most of my face is so cold. I live in Florida, am 51 years old, so it’s actually nice when I go outside into 80 degree heat with 80% humidity. The air conditioning makes it worse. Also my hands, sometimes my feet are affected. I am told nothing can be done about this.
Published: June 20 ::

I’m a hairdresser, and the constant vibrating of my hair dryer, causes my wrists to tighten and get a tingling sensation in my fingers. Then I get pain in my thumbs and my hands go white, cold and dead looking. My doctor has told me I have Raynaud’s phenomenon. My other symptom is that my bicep goes into a spasm and feels like a cramp.
Published: June 18 ::

I have had Raynaud’s for a number of years. Each year my illness gets worse, and I have found it hard to cope. The doctor says it’s something that I have to deal with, which is very hard. I get frost bite symptoms, and I can’t walk as my bones feel crushed together. There is no help with things like heating costs etc., if you’re on a low income. People just don’t seem to understand. At times, I am housebound by this, even with a car I am not able to go out when I want.
Published: June 18 ::

I’ve recently been diagnosed with Raynaud’s and the tip of my finger died. The Dr.’s have no clue so far and my finger is green and scary looking. I have never seen a documented case as bad as mine. So if you get symptoms o Raynaud’s seek medical attention A.S.A.P.
Published: June 10 ::

I have suffered with Raynaud’s phenomenon my whole life and it’s on my mind every day cause the slightest change in temperature or working with water brings it on. I’m a 20 yr old male and my hands look like a 90 yr old man which is bad for my self esteem. I have just started learning about the disease and by the sound of things there is no cure.
Published: June 09 ::

I’m cold all the time! Winter is the hardest because we live far north and it gets below 0 a lot. I turn blue/purple in the winter and I also have rosacea, which makes me turn bright red in heat and when I exercise.
Published: June 09 ::

I like to walk my dog very early each morning (before 6 a.m. if possible). Unfortunately, I can no longer do this in wintertime. In fact, walking at any hour during the winter anymore can be an exercise in agony. This is due to my Reynaud’s Phenomenon where the cold causes the blood vessels in my finger tips and the tips of my toes to clamp shut, causing me intense pain. When that happens, I must get back home ASAP as I just can’t handle the pain.
Published: June 30 ::