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When the circulation of the extremities is impaired, it is not always due to atherosclerotic
occlusive disease. Impairment of the circulation to the hands or feet may be caused
by intermittent vasospasm of the smaller arteries. This is a frequent consequence
of trauma, for example, especially in young people. The sympathetic nervous system
of young people in general, and more specifically, young women, is very “reactive”.
In response to traumatic injuries (to the leg or arm most commonly) the blood vessels
of the affected extremity can go into spasm leading to a cold, pale, extremity.
When this condition occurs in the absence of trauma, the vasospasm of small arteries
of the hands and feet is called “Raynaud's phenomenon”.
Raynaud's phenomenon is a vasospastic disorder causing discoloration of the fingers,
and toes. It is an exaggeration of vasomotor responses to cold or emotional stress.
It is an abnormal activation of the sympathetic nervous system which causes extreme
vasoconstriction of the peripheral arteries, leading to tissue hypoxia. The condition
was described by a French physician named Maurice Raynaud (1834–1881). The phenomenon
is frequently triggered by exposure to cold or by emotional stress.
Raynaud's phenomenon can occur in the absence of any other identifiable medical
condition. This is called Raynaud’s disease or “primary
Raynaud’s phenomenon”. When it is associated with some other disease, it is called
Raynaud’s Syndrome or “secondary Raynaud’s phenomenon”.
In the worst cases (which fortunately is unusual), the vasospasm can be so severe
that the fingertips or toes develop ulcerations or gangrene due to lack of circulation.
The phenomenon is more common in women than men. It is not uncommon. One study reported
an incidence of 5% in men and 8% in women.
Raynaud’s phenomenon results from an exaggerated vasoconstriction of digital arteries
and arterioles. These vascular changes induce pallor or cyanosis of the digits of
the hands or feet. Characteristically, the involved digits show red, white, and
blue color changes from most proximal to most distal. The nose, earlobes, or lips
can also be involved.
It is important to distinguish Raynaud's disease from Raynaud’s syndrome. In order
to differentiate between these two forms of Raynaud's, a doctor will conduct a number
of laboratory tests.
Primary Raynaud’s: Raynaud's disease, or "Primary Raynaud's", is diagnosed if the
symptoms are idiopathic, that is, if they occur by themselves and not in
association with other diseases. Some refer to Primary Raynaud's disease as "being
allergic to coldness". It often develops in young women in their teens and early
adulthood. Smoking worsens frequency and intensity of attacks, and there seems to
be a hormonal component. Caffeine also worsens the attacks. Sufferers are more likely
to also have migraines and angina.
There is no operative approach that has been proven to be of merit over the long
term (cervical sympathectomy had been used in previous times), but there are pharmacologic
treatments for this condition. A general recommendation however, is to carefully
avoid exposure to cold and tobacco products.
Secondary Raynaud's: Raynaud’s syndrome is the occurrence of Raynaud’s phenomenon
in association with another condition. These conditions include:
Systemic lupus erythematosus
Mixed connective tissue disease
Cold agglutinin disease
Cytotoxic drugs - particularly chemotherapeutics
Jobs involving vibration
Exposure to the cold (e.g. by working as a frozen food packer)
Raynaud's phenomenon can sometimes be the first sign of a disease syndrome. Raynaud’s
phenomenon can be part of the CREST syndrome, for example,
and is often the first presentation of this condition.
Treatment of primary Raynaud's focuses on avoiding triggers. One should try to avoid
environmental triggers, e.g. cold, vibration, emotional stress, etc. It is recommended
that the hands, feet and head are kept warm — especially your fingers, toes, ears,
and nose — by wearing mittens, insulated footwear, a ski mask; or using hand and
Smoking and caffeine should be avoided. All medications (including those obtained
over the counter) should be discussed with your physician. Woman experiencing Raynaud’s
phenomenon should discuss the best type of hormonal contraception with their gynecologist.
That can be helpful in ending an attack include running warm (not hot) water over
the area affected. Continue this process until the white area returns to its normal,
Treatment for Raynaud's phenomenon may include prescription medicines that dilate
blood vessels, such as calcium channel blockers (nifedipine) or diltiazem. These
drugs can cause headache, flushing or ankle swelling as side effects. Angiotensin
II receptor antagonists (such as Losartan) have been reported to reduce the frequency
and severity of attacks. In one reported study, sildenafil (Viagra) improved both
microcirculation and symptoms in patients with secondary Raynaud's phenomenon. Antidepressant
medications may reduce the frequency and severity of episodes if caused mainly by
psychological stress. RayVa is a topical cream for the treatment of Raynaud's phenomenon.
It contains prostaglandin E1 as the active ingredient and a permeation enhancer.
In severe cases, a sympathectomy can be performed. Infusions of prostaglandins,
e.g. prostacyclin, may also be tried. More recently, Botox has been used in severe
cases with improvement reported. Biofeedback has occasional been helpful in selected
Many other treatments have been suggested and tried. Some success has been reported
with The Ayurvedic oil preparation Mahanarayan Oil, Ginkgo biloba, piracetam and
arginine. Biofeedback has also been employed with some reported success. Patients
should discuss any treatment with their physicians.