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Raynaud’s phenomenon

Definition

Raynaud’s phenomenon is a condition in which cold temperatures or strong emotions cause blood vessel spasms that block blood flow to the fingers, toes, ears, and nose.

Causes, incidence, and risk factors

Raynaud's phenomenon can be associated with other conditions. This is called secondary Raynaud's phenomenon. Most people with the condition are over age 30.

Common causes are:

• Diseases of the arteries, such as atherosclerosis and buerger's disease
• Drugs that cause narrowing of arteries, such as amphetamines, certain types of beta-blockers, some cancer drugs, ergot compounds, and methysergide
• Arthritis and autoimmune conditions, such as scleroderma, Sjogren syndrome, rheumatoid arthritis, and systemic lupus erythematosus
• Repeated injury, particularly from vibrations such as those caused by typing or playing the piano
• Smoking
• Frostbite
• Thoracic outlet syndrome

Raynaud's phenomenon also occurs without another disease, medication, or cause. This is called primary Raynaud's phenomenon. It is most often seen in people younger than age 30.

Symptoms

Strong emotions or exposure to the cold causes the fingers, toes, ears, or nose to become white, then turn blue. When blood flow returns, the area becomes red and then later returns to normal color. The attacks may last from minutes to hours.

People with primary Raynaud's phenomenon (no other cause or condition) have problems in the same fingers on both sides, but they do not have very much pain.

People with secondary Raynaud's phenomenon (associated with other medical conditions) are more likely to have pain in different fingers. They often have pain and tingling.

Signs and tests

The doctor will perform a physical exam. Vascular ultrasound and a cold stimulation test for Raynaud's phenomenon may be done.

Different blood tests may be done to diagnose arthritic and autoimmune conditions that may cause Raynaud's phenomenon.

Treatment

The following lifestyle changes may help people with Raynaud's phenomenon:

• Stop smoking
• Avoid caffeine
• Stop and avoid medications that cause tightening or spasms of the blood vessels
• Avoid exposure to cold in any form. Wear mittens or gloves outdoors and when handling ice or frozen food. Avoid getting chilled, which may happen after any active recreational sport.
• Wear comfortable, roomy shoes and wool socks. When outside, always wear shoes.

Your health care provider may prescribe medications to relax the walls of the blood vessels. These include topical nitroglycerin, calcium channel blockers, sildenafil (Viagra), and ace inhibitors.

It is important to treat the condition causing Raynaud's phenomenon.

Support Groups

Expectations (prognosis)

The outcome varies depending on the cause and the severity of the condition.

Complications

• Gangrene or ulceration of the skin may occur if an artery becomes completely blocked (most likely to occur in people who also have arthritis or autoimmune conditions)
• Permanently decreased blood flow to the area can lead to thin and tapered fingers, with smooth, shiny skin and slow growing nails

Calling your health care provider

Call your health care provider if:

• You have a history of Raynaud's phenomenon and the affected body part (arm, hand, leg, foot, or other part) becomes infected or develops a sore
• Your fingers change color and you do not know the cause
• Your fingers or toes turn black or the skin breaks
• You have a sore on the skin of your feet or hands
• You have a fever, swollen or painful joints, or skin rashes

Prevention

Avoid exposure to the cold. Dress warmly when you cannot avoid cold. If you smoke, stop smoking, as it further constricts the blood vessels.

References

Bakst R, Merola JF, Franks AG Jr., Sanchez M, Perelman RO. Raynaud's phenomenon: pathogenesis and management. J Am Acad Dermatol. 2008;59:633-653.

Olin JW. Other peripheral arterial diseases. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 80.