Raynaud’s phenomenon

Definition

In Raynaud's phenomenon, exposure to the cold or strong emotions trigger blood vessel spasms that result in interruption of blood flow to the fingers, toes, ears, and nose. Raynaud's phenomenon can occur without any other associated symptoms or disease.

Causes, incidence, and risk factors

Raynaud's phenomenon can be associated with diseases of the arteries such as Buerger's disease and atherosclerosis, rheumatoid arthritis, scleroderma and systemic lupus erythematosus. It can also follow repeated trauma, particularly vibrations such as those caused by typing or playing the piano. An overdose of ergot compounds or methysergide may also be a cause of Raynaud's phenomenon.

Strong emotion or exposure to the cold causes the fingers, toes, ears or nose to become white, due to a lack of blood flow in the area. They then turn blue, which is a result of tiny blood vessels dilating to allow more blood to remain in the tissues. When the flow of blood returns, the area becomes red and then later returns to normal color. There may be associated tingling, swelling, and painful throbbing. The attacks may last from minutes to hours.

If the condition progresses, blood flow to the area could become permanently decreased causing the fingers to become thin and tapered, with smooth, shiny skin and slow growing nails. If an artery becomes blocked completely, gangrene or ulceration of the skin may occur.

The risk factors include associated diseases and smoking. Women are affected more often than men.

Symptoms

• toes or fingers that change color when exposed to the cold
• toes or fingers that change color upon pressure
• pain in the fingers or toes when exposed to the cold
• tingling or pain on warming

• skin redness or inflammation
• bluish skin
• paleness

Signs and tests

A physical examination of the affected parts reveals typical changes. Blood flow studies may be performed. Cold stimulation test for Raynaud's phenomenon may be performed.

Treatment

Medications to relax the walls of the blood vessels may be prescribed. Treatment of the underlying condition is important.

Avoid exposure to the cold, and when cold cannot be avoided, dress warmly. If you smoke, stop smoking, as it further constricts the blood vessels.

Expectations (prognosis)

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

Complications

• ulceration of the affected part
• gangrene of the affected part
• deformities of the fingers and fingernails and/or toes and toenails

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) develops an infection or ulceration.

Prevention

People at risk should stop smoking. Proper medical care and treatment of associated diseases are pertinent.

Illustrations

Raynaud's phenomenon

Systemic lupus erythematosus

Circulatory system