Raynauds Phenomenon

Raynaud's Phenomenon is a Disorder of the small blood vessels that feed the skin. During an attack of Raynaud's, these arteries contract briefly, limiting blood flow. This is called a vasospasm. Deprived of the blood's oxygen, the skin first turns white then blue. The skin turns red as the arteries relax and blood flows again. Extremities--hands and feet--are most commonly affected, but Raynaud's can attack other areas such as the nose and ears.

Doctors classify Raynaud's phenomenon as either the primary or the secondary form. In medical literature, "primary Raynaud's phenomenon" may also be called Raynaud's disease, idiopathic Raynaud's phenomenon, or primary Raynaud's syndrome. The terms idiopathic and primary both mean that the cause is unknown.

Most people who have Raynaud's phenomenon have the primary form (the milder version). A person who has primary Raynaud's phenomenon has no underlying disease or associated medical problems. More women than men are affected, and approximately 75 percent of all cases are diagnosed in women who are between 15 and 40 years old, but anyone can have the problem. It is not known for sure how many people suffer from these symptoms, but Raynaud's is a common problem.

People who have only vasospastic attacks for several years, without involvement of other body systems or organs, rarely have or will develop a secondary disease (that is, a connective tissue disorder such as scleroderma) later. Several researchers who studied people who appeared to have primary Raynaud's phenomenon over long periods of time found that less than 9 percent of these people developed a secondary disease.

Symptoms include changes in skin color (white to blue to red) and skin temperature (the affected area feels cooler). Usually there is no pain, but it is common for the affected area to feel numb or prickly, as if it has fallen asleep.

Doctors do not completely understand the cause of Raynaud's, but they believe the body's blood vessels overreact to cold.

When the body is exposed to cold, the hands and feet lose heat rapidly. To conserve heat, the body reduces the amount of blood flowing to these areas by narrowing the small arteries that supply them with blood. In persons with Raynaud's, these small blood vessels overrespond to cold. For example, reaching into a refrigerator may trigger an attack.

Cold temperatures are more likely to provoke an attack when the individual is physically or emotionally stressed. For some persons, exposure to cold is not even necessary; stress alone causes vessels to narrow.

Although secondary Raynaud's phenomenon is much less common than the primary form, it is often a more complex and serious disorder. Secondary means that patients have an underlying disease or condition that causes Raynaud's phenomenon. Connective tissue diseases are the most common cause of secondary Raynaud's phenomenon. Some of these diseases reduce blood flow to the digits by causing blood vessel walls to thicken and the vessels to constrict too easily. Raynaud's phenomenon is seen in approximately 85 to 95 percent of patients with scleroderma and mixed connective tissue disease, and it is present in about one-third of patients with systemic lupus erythematosus. For most people with lupus, Raynaud's phenomenon acts like the primary form of the disorder. Raynaud's phenomenon also can occur in patients who have other connective tissue diseases, including Sjogren's syndrome, dermatomyositis, and polymyositis.



Possible causes of secondary Raynaud's phenomenon, other than connective tissue diseases, are carpal tunnel syndrome and obstructive arterial disease (blood vessel disease). Some drugs, including beta-blockers (used to treat high blood pressure), ergotamine preparations (used for migraine headaches), certain agents used in cancer chemotherapy, and drugs that cause vasoconstriction such as some over-the-counter cold medications and narcotics are linked to Raynaud's phenomenon.

People in certain occupations may be more vulnerable to secondary Raynaud's phenomenon. Some workers in the plastics industry (who are exposed to vinyl chloride) develop a scleroderma-like illness, of which Raynaud's phenomenon can be a part. Workers who operate vibrating tools can develop a type of Raynaud's phenomenon called vibration-induced white finger. In addition, people whose fingers are subject to repeated stress, such as typing or playing the piano, are more vulnerable to the disorder.

People with secondary Raynaud's phenomenon often experience associated medical problems. The more serious problems are skin ulcers (sores) or gangrene (tissue death) in the fingers or toes. Painful ulcers and gangrene are fairly common and can be difficult to treat. In addition, a person may experience heartburn or difficulty in swallowing. These two problems are caused by weakness in the muscle of the esophagus (the tube that takes food and liquids from the mouth to the stomach) that can occur in people with connective tissue diseases.

People suffering from Raynaud's should protect themselves from cold and keep all parts of their body warm--not just their extremities. Outdoors in winter, they should wear scarves, warm socks and boots, and mittens or gloves under mittens because gloves alone allow heat to escape. People with Raynaud's should also wear wristlets to close the space between the sleeve and mitten. Indoors, people should wear socks and comfortable shoes. When taking food out of the refrigerator or freezer, they should wear mittens, oven mitts, or pot holders.

Patients with Raynaud's should guard against cuts, bruises, and other injuries to the affected areas. Activities such as sewing may have to be limited.

Patients who smoke should quit. Doctors may also adjust medications if the drugs appear to be responsible for the symptoms.

After several sessions of training, patients can often prevent or stop attacks using biofeedback, a technique in which patients are taught to "think" their fingers or toes warm.

It is important for persons who suspect they have Raynaud's to talk with their personal physicians. The doctor can give advice on the best ways to manage and treat the problem.

  • U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, NIH Publication No. 93-22630, Reprinted July 1993