Skin discoloration occurs because an abnormal spasm of the blood vessels causes a diminished blood supply to the local tissues. There is a characteristic three-phase color sequence: Initially, the digits involved turn white because of the diminished blood supply; then they turn blue because of a prolonged lack of oxygen; finally, the blood vessels reopen, causing a local flushing phenomenon, which turns the digits red.
The most recent surveys show that Raynaud's phenomenon may affect 5 to 10 percent of the general population in the United States. Women are more likely than men to have the disorder, and approximately 75 percent of all cases are diagnosed in women between 15 and 40 years old.
Raynaud's phenomenon appears to be more common in people who live in colder climate zones, but people with the disorder who live in milder climates may have more attacks during periods of colder weather.
Types and possible causes of the phenomenon
There are two different types of Reynaud’s phenomenon. In medical literature, primary Raynaud's phenomenon may also be referred to as “Raynaud's disease”, “idiopathic Raynaud's phenomenon”, or “primary Raynaud's syndrome”.
* Primary Raynaud's phenomenon
This is the milder version of the disorder. Most people affected by Raynaud's phenomenon have the primary form.
A patient with primary Raynaud's phenomenon typically has no underlying disease or associated medical problems. People who suffer only from attacks for several years, without involvement of other body systems or organs, rarely have or will develop a secondary disease later. Less than 9 percent of these develop a secondary disease later in life.
* Secondary Raynaud's Phenomenon
Although secondary Raynaud's phenomenon is much less common than the primary form of the disorder, it is significantly more serious. Patients have some underlying disease or condition that causes Raynaud's phenomenon. Connective tissue diseases are the most common cause of secondary Raynaud's phenomenon.
Possible associated connecting tissue disorders include:
* Sjögren's syndrome
Possible causes of secondary Raynaud's phenomenon, other than connective tissue diseases, are:
* Carpal tunnel syndrome
* Obstructive arterial disease
* Drug use (beta-blockers, ergotamine preparations, certain agents used in cancer chemotherapy)
People in certain occupations may be more vulnerable to secondary Raynaud's phenomenon. For example, workers in the plastics industry are greatly jeopardized because of exposure to vinyl chloride. Workers who operate vibrating tools can develop a type of Raynaud's phenomenon called vibration-induced white finger. In addition, people whose fingers are subject to repeated stress, such as typing or playing the piano, are also more vulnerable to the disorder.
Symptoms of the phenomenon
Symptoms of Reynaud’s phenomenon depend on the severity, frequency, and duration of the blood vessel spasm. Most patients with mild disease only notice skin discoloration after the hands or feet have been exposed to cold, but they may also experience mild tingling and numbness of the involved digit that will disappear once the color returns to normal. Only in a small percentage of the cases poor oxygen supply to the tissue can cause the tips of the digits to ulcerate. Ulcerated digits can become infected, and if lack of oxygen continues, gangrene can occur. Patients with secondary Reynaud’s phenomenon can also have symptoms related to their underlying diseases. Other rheumatic diseases frequently associated with RP include systemic lupus erythematosus, rheumatoid arthritis, and Sjogren's syndrome.
So, to recap, the most common symptoms are:
* A pattern of color changes in the fingers: pale, then blue, then red
* Hands may become swollen and painful when warmed
* Ulcerations of the finger pads
* Gangrene may develop in the fingers
Diagnosis of Reynaud’s phenomenon
It isn’t too hard to diagnose the condition, but it can be extremely difficult to identify its specific form.
* Nailfold Capillaroscopy: This is a useful diagnostic test, helping doctors determine the form of Raynaud’s. During this test capillaries are studied under strong magnification with a special type of microscope. For people with primary Raynaud’s phenomenon, the results of this test will be normal; the results are abnormal for those who have the secondary form.
* Antinuclear Antibody Test (ANA): This test can tell whether the body is producing special antibodies that commonly occur in people who have connective tissue diseases.
* Erythrocyte Sedimentation Rate (ESR): This test measures inflammation in the body and tests how fast red blood cells settle out of unclothed blood. Inflammation in the body will cause an elevated ESR.
Treatment of Raynaud's phenomenon
The goal of treatment is to reduce the number and severity of attacks, and to prevent tissue damage and loss in the fingers and toes. Several non-drug treatments can help decrease the severity of a Raynaud's attack.
1. A Raynaud’s attack should not be ignored. Taking the proper steps, both length and severity of the attack can be decreased. Running warm water over the fingers or toes, or soaking them in a bowl of warm but not hot water will warm them up. However, it has been proven that excessive heat can promote gangrene.
2. Not only is it important to keep hands and feet warm, but it is also helpful to avoid chilling any other part of the body. A patient should wear several layers of loose clothing, socks, hats, and gloves or mittens. Hats are particularly important because a great deal of body heat is lost through the scalp.
3. Nicotine causes skin temperature to drop, which might lead to an attack. All the patients should do their best to quit smoking as soon as possible.
4. Because stress might trigger an attack, particularly for people who have primary Raynaud's, a patient should learn to recognize and avoid stressful situations.
5. Patients with Raynaud's phenomenon should exercise regularly, because exercise promotes an overall sense of well-being, increases energy level, helps control weight, and promotes restful sleep.
It is much easier to cure people with secondary Raynaud's phenomenon than those with the primary form. Keep in mind that the treatment is not always successful, however. Many health care professionals believe that the most effective and safest drugs are calcium-channel blockers. These medications relax smooth muscles, dilate the small blood vessels, and decrease the frequency and severity of attacks in about two-thirds of patients with either primary or secondary Raynaud's phenomenon.
Other medicines that can help include:
* Alpha blockers - Their primary role is to counteract norepinephrine, a hormone that constricts blood vessels
* Vasodilators – Drugs whose primary role is to relax the blood vessels. Most common are nitroglycerine paste, applied to the fingers to help heal skin ulcers.