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Raynaud's Disease

Raynaud’s disease is a condition which results in areas of the body including the toes, fingers, tip of the nose, and ears to feel cold and numb in response to temperature changes especially cold temperatures and stress. The small blood vessels in these regions become narrowed and decrease the blood flow resulting in color changes of the skin with the first response being a whitish color due to the lack of blood flow followed by bluish color from decreased oxygen. Once the blood flow returns, skin will appear red from a flushing effect of the returned blood. Raynaud’s is more common in women usually starting in the 30’s and may be present the rest of her life. It also occurs more commonly in people living in colder climates. This condition can occur by itself or in association with other diseases, especially autoimmune diseases. The cause is unknown but it has been theorized that an abnormal nerve control of the blood vessels that results in the spasm of the muscles lining the walls of the blood vessels thus producing a narrowing of the blood vessel and reducing the flow of blood.

What are the symptoms associated with Raynaud’s disease?
Raynaud’s disease is more than just having cold hands or feet. The symptoms that occur depend on the severity of the blood vessel spasms and how long they last. During the attack, once the area turns blue, decreased sensations may occur. The person may not be able to judge temperature sensations, feel smoothness or roughness of an object, and may cut the skin with a sharp object and not sense it. When the blood supply returns, throbbing, tingling or swelling may occur. The attack may affect only a couple of fingers or toes and when another attack occurs it may affect different parts of the body. The duration of the attack can vary from a few minutes to several hours. The symptoms are stimulated by cold and stress. The cold factors may be as simple as removing something from the refrigerator or washing hands in cold water. Emotional stress can also bring on attack.

What are the types of Raynaud’s disease?
There are two main types of Raynaud’s disease:

  • Primary Raynaud’s – this condition occurs without any obvious underlying medical condition. It is the more common form of the disease
  • Secondary Raynaud’s – this condition is associated with other underlying medical conditions or can be brought on by certain medications or conditions. This form tends to be the more severe form.

What conditions or disease can bring on Secondary Raynaud’s?
The conditions may vary from diseases, medications, or trauma and include:

  • Autoimmune diseases – scleroderma, lupus, sjogren’s syndrome and rheumatoid arthritis
  • Disorders or the blood vessels – atherosclerosis (a disorder of plaque buildup in the arteries which decrease blood flow), Buerger’s syndrome (a disorder of inflammation of the blood vessels in the feet and hands), or pulmonary hypertension (elevated blood pressure in the arteries of the lungs).
  • Repetitive trauma – frostbite, chronic use of vibrating tools or playing a piano for long periods of time or pounding the keys hard
  • Carpal tunnel syndrome – pressure on the nerves in the hands producing numbness and pain and making the tissues more susceptible to temperature change.
  • Injuries – prior injuries of the hands and feet such as fractures of the wrist and ankles
  • Smoking – nicotine causes a constriction of the blood vessels that may lead to Raynaud’s
  • Thyroid disease – especially low thyroid production
  • Chemical exposure – chemical workers in the plastics industry in which vinyl chloride is used have seen a higher risk of Raynaud’s

Medications:

  1. Migraine medications such as ergotamine
  2. High blood pressure medications – beta blockers
  3. Estrogen when used without progesterone
  4. Over the counter cold medications
  5. Chemotherapy agents

Your doctor may want to run blood tests to rule out other diseases but there is no blood test specifically for Raynaud’s. Current therapies to reduce the severity of the disorder can include medications to relax the blood vessel spasms including calcium channel blockers, alpha blockers, and vasodilators. The goal of treatment is to reduce the number and severity of the attacks and prevent damage to the tissues.

What can you do to decrease the attacks?

  • Stop smoking – smoking reduces skin temperature by narrowing blood vessels. Second hand smoke may produce the same effect
  • Control stress – learn to recognize situations that are stressful and attempt to learn to control the situation or avoid the stressor
  • Avoid caffeine – caffeine produces a narrowing of blood vessels and may increase symptoms of Raynaud’s
  • Take care of your feet and hands – take care of your nails to avoid injury and infections. Attempt to avoid injury so don’t walk barefoot. Avoid compression to blood vessels (tight wristbands, rings or shoes).
  • Biofeedback – using your mind with guided imagery, deep breathing and relaxation techniques have helped some individuals
  • Vitamin B3 – niacin causes blood vessel dilatation to increase blood flow to the skin
  • Dress warmly – particularly in cold weather and climates

If you think you might suffer from Raynaud’s disease consult your physician. Be prepared to talk to your physician by having a list of your symptoms, your medical conditions, and medications.

More about Dr. Aulds

Donald G. Aulds, MD is an Obstetrician and Gynecologist and currently serves as the Medical Director for both the Women's Center and the Best Start Program of North Alabama. He is a Diplomat of the American Board of Obstetrics and Gynecology and Fellow of the American College of Obstetricians and Gynecologists.

Dr. Aulds completed his medical education at Louisiana State University School of Medicine, New Orleans, LA and his Internship and Residency in Obstetrics and Gynecology at Ochsner Medical Foundation, New Orleans, LA.

Dr. Aulds has been an active member of the Huntsville Hospital Medical Staff since 1980.