Raynaud’s Phenomenon (pronounced Ray-NOSE) was named for Maurice Raynaud, the French doctor who first described it in 1862. It is a condition of the circulatory system in which the extremities (the toes, fingers, and ears) become unusually sensitive to cold temperatures or emotional stress.
When the affected person is exposed to a situation that produces stress or anxiety, the arteries feeding the toes and fingers respond by constricting, causing the affected digits to feel cold, numb, and painful.
This response is called a vaspospasm, and it can be provoked by even the most trivial drop in temperature—for example, by stepping into a pool of slightly cold tap water.
This response is normal, to some extent; the body’s response to cold temperatures has evolved as a way to maintain core body temperature under freezing conditions (thereby protecting the brain and internal organs) by reducing blood flow to our extremities, which minimizes unnecessary heat loss.
In a person who suffers from Raynaud’s Phenomenon, however, this response is exaggerated, and can be triggered with very little provocation. These attacks can be brief, lasting only a minute or so, or they can last for hours.
According to the Raynaud’s Association, 28 million Americans (about 5 percent of the population) suffer from this condition. Because the symptoms are seldom more than a nuisance, many of these people never seek treatment or even realize they have a medical condition; they often think, I just have poor circulation in my feet.
Which Symptoms of Raynaud’s Phenomenon Should I Look For?
The symptoms Raynaud’s sufferers experience during attacks include
- Throbbing pain
- Changes in skin color—skin may turn white as circulation becomes restricted, then blue as oxygen deprivation begins to affect the tissues.
When the attack ends and circulation is restored, the affected toes will usually turn bright red, and tingling sensations will increase for a while before abating.
People who suffer chronic Raynaud’s attacks will sometimes have brittle nails with longitudinal ridges. Sometimes just one or two toes will be affected, usually the same ones on each foot.
Primary and Secondary Raynaud’s Phenomenon
There are two recognized types of Raynaud’s Phenomenon—primary and secondary.
Primary Raynaud’s Phenomenon exists with no apparent cause, in the absence of any underlying condition or disease known to provoke vascular spasms, and is much more common among women and among people who live in cold climates. The primary type of this condition is also called Raynaud’s Disease, and it is more common than secondary Raynaud’s. It tends to develop between the ages of 20 and 40.
Secondary Raynaud’s Phenomenon involves an underlying condition that is observed to cause the attacks. It often occurs in people over the age of 40 (depending on condition that causes it), and is more likely than primary Raynaud’s to be painful.
Causes and Risk Factors of Raynaud’s Phenomenon
The risk factors for primary Raynaud’s Phenomenon include:
- Age—the condition usually develops in ages 20–40.
- Gender—by some estimates, women are nine times more likely to suffer this condition than men, and 75 percent of all cases of primary Raynaud’s are women aged 15 to 40.
- Climate—people who live in colder climates are more often subjected to temperature extremes that can trigger attacks.
- Family History—while there is not yet any solid evidence of a genetic cause, there is some anecdotal evidence suggesting that in many cases more than one family member is affected.
The risk factors for secondary Raynaud’s Phenomenon include:
- Diseases such as scleroderma, Buerger’s disease, and lupus
- Excessive caffeine intake
- Constant use of vibrating tools such as jackhammers, chainsaws, etc.
- Constant repetitive motion such as typing or playing the piano
- Having previously suffered frostbite
- Carpal tunnel syndrome
- Peripheral vascular disease
- Thyroid disease
What Are The Complications of Raynaud’s Phenomenon?
Truly severe cases of Raynaud’s Phenomenon are rare, but people who suffer from extremely bad cases may get ulcers on affected toes, and in very rare cases tissue death may result from impaired circulation, leading to gangrene.
How is Raynaud’s Phenomenon Diagnosed?
Raynaud’s Phenomenon shares many symptoms with chilblains, and one condition can sometimes be misdiagnosed as the other.
If your doctor suspects Raynaud’s, however, he or she will probably want to perform a nailfold capillaroscopy in order to determine whether you have primary or secondary Raynaud’s Phenomenon.
During the course of this procedure the doctor will examine your nailfold (the skin at the base of the nail) under a microscope or a hand-held ophthalmoscope in order to study the tiny blood vessels called capillaries.
The doctor will be looking for abnormalities—if the capillaries are enlarged, for example, this may indicate that you suffer from an underlying tissue disease that may be causing your symptoms.
Your doctor may also want to conduct blood tests to rule out certain autoimmune diseases that can cause symptoms of Raynaud’s Phenomenon.
How is Raynaud’s Phenomenon Treated?
No cure exists for primary Raynaud’s, but there are certain types of drugs that can dilate blood vessels to reduce the severity of attacks:
- Vasodilators, which open up blood vessels
- Calcium-channel blockers, which lower blood pressure by preventing calcium from being absorbed by the cells of blood-vessel walls:
- Felodipine (Plendil)
- Nifedipine (Procardia)
- Verapamil (Calan, Isoptin)
- Bepridil (Vascor)
- Amlodipine (Norvasc)
- Diltiazem (Cardizem)
- Nisoldipine (Sular)
- Alpha blockers (which can help prevent blood-vessels constriction):
- Doxazosin (Cardura)
- Prazosin (Minipress)
If you suffer from Raynaud’s Phenomenon, there are many steps you can take to prevent attacks or reduce their duration or severity:
- Swing your arms around when you feel an attack coming on; this helps to encourage blood circulation
- If possible, stick your feet into a tub of warm water as soon as an attack begins
- Exercise regularly—this is good for your circulation in general, and it also promotes a general sense of well being, which may reduce stress and prevent anxiety attacks that can lead to Raynaud’s attacks.
- Limit your intake of caffeine and nicotine
- Consume foods high in omega-3 fatty acids, which are found in fish oil. This has been found to help minimize the symptoms of primary Raynaud’s Phenomenon.
In very rare cases, surgery might be considered to cut the nerves that open and close the arteries of the affected digits.
This is only a last resort to avoid amputation, however, and cases of Raynaud’s Phenomenon severe enough to justify even considering such a drastic step are extremely rare.