Raynaud's Phenomenon

What is Raynaud's phenomenon?

Raynaud's phenomenon is a disorder of the small blood vessels that feed the skin. During an attack of Raynaud's, these blood vessels narrow briefly, limiting blood flow to the skin. The skin first turns white, then blue. Then the skin turns red as the vessels relax and blood flows again. Hands and feet are most commonly affected, but Raynaud's phenomenon can affect other areas such as the nose and ears.

Women between the ages of 15 and 50 are most often affected, but anyone can have the problem.

How does it occur?

For most people, an attack is usually triggered by exposure to cold or emotional stress. For example, reaching into a refrigerator may trigger an attack.

There are 2 forms of Raynaud's phenomenon. Most people who have Raynaud's phenomenon have the primary form (the milder version). Primary Raynaud's usually affects both hands and both feet. Its cause is not known.

Secondary Raynaud's phenomenon is caused by another disease or condition and is a more serious disorder. It usually affects both hands or both feet. Connective tissue diseases are the most common cause. Medical conditions that may cause secondary Raynaud's phenomenon include:

• Scleroderma (a thickening and hardening of the skin and other body tissues). Raynaud's phenomenon is seen in approximately 85 to 95% of people with scleroderma.
• Systemic lupus erythematosus (a chronic inflammation of the skin and organ systems).
• Rheumatoid arthritis (a chronic inflammation and swelling of tissue in the joints).
• Blood flow reduction (problems that slow or stop blood flow in a vessel, such as inflammation and hardening of the arteries).
• Pulmonary hypertension (high blood pressure in the lungs).
• Sjögren's syndrome (a disorder in which immune cells attack and destroy the glands that produce tears and saliva).
• Polymyositis (a chronic disease that causes inflammation and weakness of the muscles).
• Dermatomyositis (a form of polymyositis with skin symptoms).
• Carpal tunnel syndrome (a painful disorder of the hand and wrist caused by pressure on a nerve in the wrist).

Some drugs may cause Raynaud's phenomenon. Examples of such drugs are beta blockers used to treat high blood pressure, ergotamine medicines used for migraine headaches, anticancer drugs, nonprescription cold medicines, and narcotics. Smoking can also cause Raynaud's phenomenon.

Injuries from frostbite, surgery, or some jobs may also cause Raynaud's phenomenon. Some workers in the plastics industry who are exposed to vinyl chloride develop a scleroderma-like illness and have Raynaud's phenomenon. Regular use of machinery such as chain saws and vibrating drills can hurt blood vessels.

What are the symptoms?

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

How is it diagnosed?

Your healthcare provider will ask about your medical history and examine you. You may have blood tests. Depending on your history and exam, your provider may check for diseases or other conditions that cause secondary Raynaud's.

How is it treated?

Most healthcare providers recommend nondrug treatments and self-help measures first, as described below in the section on taking care of yourself.

Several kinds of medicines are sometimes used to treat severe Raynaud's symptoms. They all improve circulation. Types of drugs that might be prescribed are calcium channel blockers, alpha blockers, and vasodilators. Nitroglycerin paste, which is applied to the fingers, helps heal skin sores.

A drug may become less effective over time. Women of childbearing age should know that the medicines used to treat Raynaud's phenomenon might affect the baby. If you are pregnant or are trying to become pregnant, talk with your healthcare provider before taking these medicines.

If you are taking a medicine that seems to be causing Raynaud's phenomenon, let your healthcare provider know. You may need to change your medicine or dosage.

How long do the effects last?

Raynaud's phenomenon cannot be cured, but most people are able to manage the symptoms.

How can I take care of myself?

• Protect yourself from cold and keep all parts of your body warm. When you are outdoors in the winter, wear scarves, warm socks, boots, and mittens. (Mittens are better than gloves, which allow too much heat to escape.) Make sure your wrists are covered. Indoors, wear socks and comfortable shoes. When taking food out of the refrigerator or freezer, use mittens, oven mitts, or potholders.
• Guard against cuts, bruises, and other injuries to the areas affected by Raynaud's phenomenon.
• If you smoke, quit. Smoking can further decrease blood flow to the fingers.
• You may be able to prevent or stop attacks using biofeedback, a technique in which you are taught to "think" your fingers or toes warm.
• Control stress.
• Exercise regularly, according to your healthcare provider's recommendations.
• See your healthcare provider if you have questions or concerns.

For more information, you may wish to contact:

National Institute of Arthritis and Musculoskeletal and Skin Diseases Phone: 877-22-NIAMS (226-4267) (free of charge) Web site: http://www.niams.nih.gov

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