Raynaud's disease
Raynaud's disease
Raynaud's disease is a condition affecting the circulation of blood in the fingers and toes, usually when exposed to cold, sudden temperature changes or emotional stress. Symptoms include fingers and toes turning a distinctive white or blue colour and becoming numb. When warmed they turn red and painful throbbing replaces the numbness.
It is a progressive condition, meaning it tends to worsen. Initially it may only affect the tips of the fingers or toes, but over time may affect whole fingers and toes. The rate of progression differs greatly amongst individuals.
Types of Raynaud’s disease
There are two types of Raynaud’s disease – Primary and Secondary:
Primary Raynaud’s disease
In these cases, the cause of the condition is unknown. It does run in families, however, so a genetic cause is suspected. Primary Raynaud’s disease is the more common form and affects women more than men. It usually starts in a person's teenage years or twenties.
Primary Raynaud’s disease is usually a mild condition and produces few complications. In rare cases the condition progresses rapidly.
Secondary Raynaud’s disease
Secondary Raynaud’s disease is so called because it occurs secondary to another condition or factor, such as:
- Diseases that affect the skin and joints eg: scleroderma, rheumatoid arthritis or systemic lupus erythematosus (SLE)
- Medications that narrow the blood vessels, eg: beta-blockers, decongestants and some chemotherapy drugs
- Hormone imbalances eg: hypothyroidism
- Injury eg: frost bite
- Occupational exposure to constant vibration (eg: chainsaws) or repetitive movement (eg: typing).
Secondary Raynaud's disease can develop at any age.
Signs and symptoms
Raynaud’s disease occurs in “episodes”, where symptoms are present for a period of time, and then resolve. Most episodes occur in response to exposure to cold or emotional stress. An episode tends to come on very quickly and can last for minutes or a number of hours. The symptoms experienced during an episode of Raynaud’s disease will depend on the severity, frequency and duration of the blood vessel spasm.
In mild cases, only skin discolouration or minor tingling may be experienced. In more severe cases the lack of oxygen can irritate nerves, causing pain, and can damage the tissues beneath the skin. In rare cases the prolonged lack of oxygen can cause cracked skin or chilblains, or small ulcers at the tips of the fingers.
There are three distinct phases to an episode of Raynaud’s disease:
- Small arteries become narrow (constrict), reducing the flow of blood through them. The affected fingers and toes become pale due to lack of blood.
- Lack of oxygen causes the affected fingers and toes to become blue in colour. They may also feel cold, numb and tingly.
- The arteries dilate again, increasing blood flow and causing the affected fingers and toes to flush bright red. They may also feel warm and may throb painfully.
A general feeling of tightness in the affected area may also be experienced during an episode.
Treatment
If Raynaud's disease is suspected, medical advice should be sought. A referral to a dermatologist may be recommended. There is no known way to prevent the development of Raynaud’s disease and there is no known cure for the condition. However, episodes can be prevented by avoiding situations that trigger them. Practical steps that can help to achieve this include:
- Keeping warm and maintaining a constant body temperature
- Wearing gloves and warm socks when out in the cold
- Not smoking – nicotine can narrow the blood vessels
- Not directly handling cold things eg: bottles of milk, items out of the freezer
- Keeping the skin supple by using moisturisers
- Learning how to manage stress and emotional situations
- Avoiding medications that can aggravate blood vessel spasm eg: beta blockers and some cold and flu medications
Where treatment is required, this may include:
- Warming the hands and feet with clothing or warm water
- Medications to widen the blood vessels and promote circulation (eg; calcium channel blockers, alpha blockers, vasodilators)
- Medications to thin the blood eg: aspirin
- Treatment of underlying conditions in cases of secondary Raynaud’s disease
- Alternative therapies eg: massage, acupuncture
In severe cases of Raynaud’s disease, surgery to prevent the small nerves in the fingers and toes from stimulating the blood vessels to spasm may be recommended. This is known as sympathectomy and involves cutting the nerves that constrict the peripheral blood vessels. However, the procedure is not without complications and has a fairly low success rate so would normally only be considered if other approaches fail.
