Raynaud's phenomenon
Raynaud's phenomenon (RP) is a condition characterized by reduced blood flow to the extremities, primarily affecting the fingers and toes but can also involve other areas like the nose and lips. This occurs due to vasospasm, or the sudden narrowing of blood vessels, though the exact triggers remain unclear. RP is categorized into two types: primary, which is more common and occurs without any underlying health issue, and secondary, which is associated with other diseases. Approximately five percent of the U.S. population experiences RP, with symptoms often exacerbated by cold temperatures, leading to changes in skin color—from white to blue and finally red upon warming.
Diagnosis can involve various methods, including Doppler ultrasound and blood tests, to determine the type of RP present. Management typically includes lifestyle adjustments, such as avoiding cold and certain stimulants, though medications may be necessary for more severe cases. Treatments range from prescription drugs that promote blood flow to alternative therapies like acupuncture and Ginkgo biloba. In extreme instances, surgical options may be considered to alleviate symptoms. Understanding Raynaud's phenomenon is crucial for effective management and improving quality of life for those affected.
Raynaud's phenomenon
Disease/Disorder
Anatomy or system affected: Blood vessels, breasts, ears, feet, hands, mouth
Definition: The reduction of circulation in the extremities, inducing a cold- or stress-induced color change
Key terms:
prostaglandin: a group of fatty acids that act as short-range signaling molecules and mediate a wide range of body functions
sympathetic nervous system: a branch of the autonomic system that mediates the “fight or flight” response
vasospasm: sudden, spontaneous constriction of blood vessels
Causes and Symptoms
Raynaud’s phenomenon (RP) results from a sudden decrease in blood flow to the extremities, which occur most commonly in the fingers, but also can affect the toes, ears, nose, lips, and nipples. Blood vessel constriction (vasospasm) causes the sudden decrease in circulation. However, what drives vasospasm remains controversial, and many mechanisms have been proposed, but none can account for all cases of RP.
There are two types of RP: primary and secondary RP. The far more common and generally less severe primary RP occurs without an associated disease or an apparent cause (idiopathic). Secondary RP results from some other underlying disease. Diseases of connective tissue, eating disorders, certain drugs or occupations, infectious diseases, environmental conditions, and other miscellaneous effects can cause RP.
About five percent of the population in the United States has RP. In people with RP, exposure to cold causes the skin of the fingers or toes to whiten and feel cold and numb. Over time, the skin turns a bluish tint (cyanosis). Upon warming, the skin turns red and then normal, accompanied by swelling, tingling, and a kind of “pins and needles” feeling.
After experiencing repeated episodes of oxygen depletion, the skin of the extremities can become thin and fragile. Ulcers can form and the nails of the hands and toes can deform. In very severe cases the fingers and toes and become gangrenous.
Treatment and Therapy
Although the above-mentioned symptoms can justify a diagnosis of RP, Doppler ultrasound tests can effectively assess the blood flow in the extremities, as can digital artery pressure tests. Capillaries can be examined under a microscope in a procedure known as nailfold capillaroscopy. Blood tests such as a complete blood count, antinuclear antibody test, and erythrocyte sedimentation rate can be used to determine whether an individual has primary or secondary Raynaud’s.
In most cases, avoiding the cold or stresses that cause the attacks can suffice. Avoiding caffeine or other compounds known to cause blood vessel constriction (e.g., pseudoephedrine) can also help. For more severe cases of RP, medication may be required. Medicines used to treat RP include calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, alpha-1 receptor blockers, angiotensin receptor blockers, the antidepressant fluoxetine (Prozac), sildenafil (Viagra), nitrates, and a topical cream called RayVa, which contains prostaglandin E1, a known dilator of blood vessels.
Alternative treatments for Raynaud’s include Gingko biloba extracts, acupuncture, laser therapy, and temperature biofeedback. All of these treatments have been shown to relieve RP symptoms to some degree in various studies.
In extremely severe cases, sympathectomy, surgically cutting the sympathetic nerves to the extremities, provides relief for some patients. In other cases grafting a vein into the extremity (bypass vein grafts) can greatly increase blood flow the hands, augment healing, and relieve symptoms.
Bibliography
Badash, Michelle. “Raynaud’s Disease and Phenomenon.” Health Library. EBSCO, Jan. 2015. Web. 18 Mar. 2015.
Laundry, Gregory J. “Current Medical and Surgical Management of Raynaud’s Syndrome.” Journal of Vascular Surgery 57, no. 6 (June, 2013): 1710–1716.
Porter, Steven B., and Peter Murray. “Raynaud Phenomenon.” Journal of Hand Surgery 38A (February, 2013): 375–378.
“Raynaud’s Disease.” MedlinePlus. US Natl. Lib. of Medicine, Natl. Inst. of Health, 3 Sept. 2014. Web. 18 Mar. 2015.
“What Is Raynaud’s?” NIH Natl. Heart, Lung, and Blood Inst. US Dept. of Health & Human Services, NIH, 21 Mar. 2014. Web. 18 Mar. 2015.