Raynaud's phenomenon

Definition
Raynaud's phenomenon is a condition that causes pain, coolness and discoloration of the fingers, toes, ears, lips or nose when exposed to cold. It primarily affects the fingers.

Causes/associated factors
The cause of Raynaud's phenomenon is unknown, but it seems to be an overreaction of the blood vessels to cold temperatures. Typically, the blood vessels in your skin constrict (narrow) when you're exposed to cold to prevent your body from losing heat. When you have Raynaud's, however, the blood vessels overreact and narrow to the point of decreasing normal blood flow. When symptoms appear, it's called a Raynaud's attack. Physical and emotional stress may make you more susceptible to attacks in cold weather. Sometimes, stress alone can trigger an attack. Because smoking constricts small blood vessels, cigarette smoking can contribute to the condition.
Raynaud's phenomenon is most common in cold climates, especially among women ages 15 to 40. The condition sometimes runs in families.


Types of Raynaud's phenomenon
Raynaud's phenomenon may be classified as primary or secondary. With primary Raynaud's, often called Raynaud's disease, you may have attacks for many years without identifying an underlying cause.
Secondary Raynaud's phenomenon is much less common, but typically more severe. An underlying cause is to blame, often a medical condition such as a connective tissue or autoimmune disease (a condition in which the body produces antibodies to fight against its own tissues). Rheumatoid arthritis (an autoimmune disease in which certain joints, often the joints of the hands and feet, are inflamed) and scleroderma (a chronic autoimmune disease typically characterized by thickening of the skin) are common culprits. Other underlying causes of secondary Raynaud's may include carpal tunnel syndrome (a condition that develops when overused wrist tendons become inflamed and swollen), the use of certain medications (including beta blockers), long-term use of vibrating machinery or repeated stress to the fingers, such as piano playing or typing.

Researchers are currently studying how Raynaud's phenomenon relates to other diseases, as well as options for drug treatment and other measures to control attacks. A recent study found people who were infected with Helicobacter pylori (H. pylori) bacteria experienced a significant decrease in the rate of Raynaud's phenomenon after the bacteria was destroyed. Further research is needed to evaluate the role of bacteria in arterial diseases such as Raynaud's phenomenon.


Signs/symptoms
Between attacks, the affected areas look normal. During an attack, you may notice:
intermittent pain, coolness and color changes in the fingers, toes, ears, lips or nose (skin color typically changes from white to blue to red)
numbness or stiffness in the affected area
sores on the fingertips
Symptoms rarely develop in the thumbs.


Diagnosis
Because there are no specific tests to definitively diagnose Raynaud's phenomenon, diagnosis is nearly always based on your medical history. You may need various tests to help the doctor determine if any underlying medical conditions are to blame. To look for inflammatory conditions, blood tests will probably measure antinuclear antibodies (ANA), erythrocyte sedimentation rate (ESR) and complete blood count (CBC). The tiny blood vessels under your nail beds may be examined under a microscope to look for abnormalities.

Treatment
Treatment usually focuses on self-care at home. If you smoke, you'll be encouraged to quit. If self-care measures fail, the doctor may prescribe medications to prevent or relieve attacks. Possible choices include calcium channel blockers (such as nifedipine), vasodilators (such as oral or topical nitroglycerin) and alpha-adrenergic receptor antagonists (such as prazosin). Other medications being investigated to treat Raynaud's phenomenon include prostaglandins and nitric oxide. Rarely, the doctor may recommend surgical removal of nerves contributing to the problem.
When you have an attack, keep the following tips in mind:

Warm the affected extremities and avoid cold temperatures as much as possible.
Soak your fingers or toes in warm (not hot) water or hold them under warm running water.
Apply warm compresses to your nose, lips or ears.
Consider using biofeedback (a technique in which you're trained to voluntarily control bodily functions, such as blood pressure, muscle tension or heart rate) to reduce emotional stress.
To prevent complications, it is important to treat each attack immediately. Consult your doctor immediately if sores begin to develop on the affected areas.


Complications
Complications may include gangrene (tissue death) and ulceration (sores) of affected areas. Sometimes, affected extremities must be amputated. Complications are often a result of ignoring attacks.

Pregnancy-specific information
Raynaud's phenomenon is not generally considered a pregnancy-related condition. Discuss any specific concerns with your doctor.

Senior-specific information
An underlying disease is nearly always to blame when Raynaud's phenomenon appears in older adults.

Prevention
To help prevent an attack, keep the following tips in mind:
Air conditioning may cause an attack. In warm weather, adjust your thermostat accordingly and wear warmer clothing if necessary.

In cold weather, stay warm by layering your clothes. You may want to wear mittens and socks to bed. Limit your time outdoors, and wear warm socks, a hat and mittens -- not gloves. It's also a good idea to cover your lips with a scarf. If you must be outside for a long time, use chemical heating pouches in your mittens, boots or shoes.

Use insulated drinking glasses, and wear gloves when pulling things out of the freezer.

If you smoke, quit.

Consider learning biofeedback to control stress.

Exercise regularly to maintain good circulation. Always consult your doctor before beginning an exercise program, however.

Avoid over-the-counter medications that can intensify an attack, such as pseudoephedrine, guaifenesin and phenylephrine -- common ingredients in many cough and cold products.