What is Raynaud's phenomenon?
Raynaud's phenomenon (RP) is a condition resulting
in a particular series of discolorations of the fingers and/or the
toes after exposure to changes in temperature (cold or hot) or
emotional events. Skin discoloration occurs because an abnormal
spasm of the blood vessels causes a diminished blood supply to the
local tissues. Initially, the digit(s) involved turn white because
of the diminished blood supply. The digit(s) then turn blue
because of prolonged lack of oxygen. Finally, the blood vessels
reopen, causing a local "flushing" phenomenon, which turns the
digit(s) red. This three-phase color sequence (white to blue to
red), most often upon exposure to cold temperature, is
characteristic of RP.
Raynaud's phenomenon most frequently affects women, especially in
the second, third, or fourth decades of life. People can have
Raynaud's phenomenon alone or as a part of other rheumatic
diseases. When it occurs alone, it is referred to as "Raynaud's
disease" or primary Raynaud's phenomenon. When it accompanies
other diseases, it is called secondary Raynaud's phenomenon.
What causes Raynaud's
phenomenon?
The causes of primary and secondary RP are unknown.
Both abnormal nerve control of the blood-vessel diameter and nerve
sensitivity to cold exposure have been suspected as being
contributing factors. The characteristic color changes of the
digits are in part related to initial blood-vessel narrowing due
to spasm of the tiny muscles in the wall of the vessels, followed
by sudden opening (dilation), as described above. The small
arteries of the digits can have microscopic thickness of their
inner lining, which also leads to abnormal narrowing of the blood
vessels.
How is
Raynaud's phenomenon treated?
Management of Raynaud's phenomenon involves protecting the fingers
and the toes from cold, trauma, and infection. Medications that
can aggravate blood vessel spasm should be avoided by patients
with RP. In patients with persistent symptoms, medications that
dilate the blood vessels can be administered.
Patients with Raynaud's phenomenon who have no symptoms other than
the color changes of extremities may require only measures to
prevent complications. Prevention measures are important in
primary and secondary RP regardless of the severity. Simple
initial care involves keeping the body warm, especially the
extremities. Warm clothing in colder environments is essential.
Cotton gloves can be helpful while searching the freezer. Room
temperatures should not be too cool. Rubber gloves protect the
hands and prevent cooling while washing dishes. Barefoot walking
should be minimized. Compression of the blood vessels by
tight-fitting wrist bands, rings, or footwear should be avoided.
Those with RP should guard their hands and feet from direct trauma
and wounds. Any wounds or infections should be treated early to
prevent more serious infections. Avoiding emotional stresses and
tools that vibrate the hand may reduce the frequency of attacks.
Biofeedback can also help to decrease the severity and frequency
of RP in some patients.
Direct and indirect (passive) smoking should be avoided by
patients with RP. The chemicals in tobacco smoke can cause
blood-vessel constriction and lead to atherosclerosis (hardening
of the arteries), which can further impair oxygen supply to the
extremities.
Care of the nails must be done carefully to avoid injuring
sensitive toes and fingertips. Ulcers on the tips of the digits
should be monitored closely by the doctor. These can become
infected. Gently applied finger splints are used to protect
ulcerated areas. Ointments that open the blood vessels
(nitroglycerin ointment) are sometimes used on the sides of
severely affected digits to allow increased blood supply and
healing.
Medications that can aggravate symptoms of RP by leading to
increased blood-vessel spasm include over-the-counter cold and
weight-control preparations, such as pseudoephedrine (Actifed,
Chlor-Trimeton, Cotylenol, and Sudafed). Beta blockers, medicines
used for high blood pressure and heart disease, can also worsen
RP. These include atenolol (Tenormin), metoprolol (Lopressor),
nadolol (Corgard), and propranolol.
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