Definition

Raynaud disease and phenomenon are problems with the blood vessels. It causes blood flow problems to the fingers ears, nose, and lips.

Constriction of Blood Vessels

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Raynaud disease (primary Raynaud) is the most common form. There are no other associated medical conditions.

Raynaud phenomenon (secondary Raynaud) is the more severe form. It occurs along with other medical conditions such as:

Causes

Blood vessels normally narrow in response to cold temperatures or emotional stress. Raynaud is an exaggerated response to these triggers. The narrow blood vessels make it difficult to get enough blood flow to certain areas of the body. Fingers are affected most often.

It is not known what causes this abnormal reaction, but it is probably related to a problem of the nervous system. Secondary Raynaud is believed to be caused by the associated disease.

Risk

Raynaud is more common in females and those aged 15-40 years old. Factors that may increase your chance of Raynaud include:

  • Activities that involve repeated stress to hands such as:
    • Typing
    • Playing piano
    • Regular operation of vibrating tools, as in construction
    • Exposure to certain chemicals
  • A connective tissue disease, such as scleroderma
  • Diseases of the arteries, including atherosclerosis
  • Injuries to the hands or feet, such as wrist fractures or frostbite
  • Smoking
  • Certain medications, such as:
    • Beta-blockers
    • Cancer chemotherapy
    • Cold remedies
    • Migraine medications containing ergotamine
    • Estrogen-containing medications

Symptoms

An attack of Raynaud may last a few minutes to a few hours. It usually comes on in response to the cold or during emotional distress. During an attack, symptoms may include:

  • Skin discoloration–color may change to white, blue, and red
    • White occurs when the arteries narrow or collapse
    • Blue appears when the fingers, toes, or other areas are not getting enough oxygen-rich blood
    • The skin turns red and may become swollen when the attack subsides and blood returns
  • Throbbing and tingling sensations, stinging, pain, and swelling of the affected area. This may occur at the end of the attack as blood flow returns to the area.

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Tests may include:

  • Nailfold capillaroscopy—study of the capillaries under a microscope
  • Thermography
  • Blood tests—to help distinguish between Primary and Secondary Raynaud, and help identify underlying autoimmune conditions:
    • Complete blood count
    • Antinuclear antibody test
    • Erythrocyte sedimentation rate

Treatment

There are several ways to reduce the symptoms of Raynaud during an attack:

Create warmth for fingers and toes

  • Run warm (not hot) water over fingers and toes as quickly as possible. However, do not place anything hot on your skin, as it may cause damage.
  • If you are outside, move inside.
  • Place your hands on a warm area of the body, such as under your armpits or on the abdomen.

Stimulate blood flow

Try to stimulate blood circulation by wiggling your fingers and toes. Make wide circles with your arms.

Medications

When the above measures fail, medications may help relieve symptoms. Medications that can affect blood vessel size include:

  • Calcium channel blockers
  • Alpha-blockers
  • Vasodilators:
    • PDE5 inhibitors
    • IV prostanoids

Surgery

Rarely, surgery may be done when symptoms are persistent and debilitating. This involves cutting the sympathetic nerves that supply the affected fingers. These nerves control the expansion and narrowing of blood vessels.

Chemical injection

Chemicals may be injected into the nerve that is responsible for the narrowed blood vessel. The chemical stops the nerve.

Treating underlying medical condition

Treating the underlying disorder will help manage the symptoms of Secondary Raynaud.

Prevention

There are no current guidelines for preventing Primary or Secondary Raynaud. To help prevent Raynaud symptoms:

  • Stay warm. Avoid cold temperatures when possible.
  • Dress in layers.
  • Wear clothing that covers extremities such as hats, gloves, or socks.
  • Learn to adapt to stressful situations.
  • If you smoke, talk to your doctor about how to successfully quit.
  • Exercise regularly.
  • Consider using biofeedback training to control body temperature.
  • Avoid the use of medications known to worsen Raynaud.

To minimize the risk of complications from Raynaud:

  • Keep skin on fingers and toes protected.
  • Avoid injuries.