Raynaud's Syndrome: The Big Chill for Fingers and Toes

Harvard Health Letters

Sufferers should try to stay as warm as possible, indoors and outside, to avoid attacks.

Blood vessel spasms can make the cold a painful experience.

In 1862, Maurice Raynaud wrote about 25 patients who developed "pale, cold fingers" in response to cold temperatures. The paleness later gave way to a bluish, then a mottled red color. The young physician believed that a nerve problem was the cause.

We now know that the changes come from a sudden spasm of blood vessels. Cold and stress normally narrow small blood vessels in the skin. This redirects blood flow away from the extremities and toward the internal organs. It's a way to conserve heat and prevent excessive blood loss in case of injury. In people with what is now called Raynaud's phenomenon (or Raynaud's syndrome or disease), the narrowing happens suddenly, completely blocking blood flow to the skin. It is a painful condition that can affect the fingers, toes, lips, ears, knees, nipples, or nose.

An episode of Raynaud's can occur with the least provocation, like reaching into the freezer, walking down the refrigeration aisle of the supermarket, or sitting in an air-conditioned theater. Episodes usually last a few minutes, but sometimes go on for longer.

There are two main types of Raynaud's. Secondary Raynaud's appears as a consequence of some larger, more encompassing condition, such as scleroderma or lupus, or as a result of nerve damage in the wrists or hands. Primary Raynaud's occurs on its own. Experts don't know why primary Raynaud's happens, and no cure has yet been found.

It isn't always easy to tell one type from the other. Your doctor will use your story, symptoms, and some blood and other tests to make a diagnosis.

In a Raynaud's episode, fingers turn white as small arteries in the skin spasm. As oxygen in the vessels is depleted, the fingers turn bluish, then red when the artery reopens and blood reenters the vessel, warming the skin.

PREVENTION AND TREATMENT

Preventing episodes is a key step for Raynaud's sufferers. Here are some measures that can help:

--Keep warm. Do what you need to do to keep your core (basically everything between your shoulders and pelvis) and extremities as toasty as possible, both inside the house and outside. This can mean everything from using glove and boot warmers when you go outside to wearing a sweater and gloves indoors.

--Avoid cigarette smoke. Nicotine and other chemicals in cigarette smoke can make blood vessels constrict.

--Nix certain medications. Over-the-counter decongestants containing phenylephrine or pseudoephedrine (Sudafed, TheraFlu, Actifed, and others), anti-migraine medications containing ergotamine (Imitrex and others), herbal preparations containing ephedra, birth control pills, the blood pressure medication clonidine (Catapres), and some beta blockers can make you more susceptible to episodes of Raynaud's.

--Act quickly to end an attack. When you notice a Raynaud's episode starting, put your hands in your armpits or rotate your arms in a whirling or windmill pattern, which can help send blood to the fingers. Soaking your hands or feet in warm (not hot) water can also help.

--Manage stress. Relaxation techniques such as deep breathing and meditation may help decrease the number and severity of attacks.

If Raynaud's is severe or gets in the way of work or daily activities, it's worth exploring other options to prevent episodes. Calcium-channel blockers have become the first line of defense, though some doctors use an alpha blocker. These drugs improve blood flow by relaxing and widening blood vessels. Commonly used calcium-channel blockers include nifedipine (Adalat, Procardia, generic) and amlodipine (Norvasc, generic), and alpha blockers include prazosin (Minipress, generic). If these medications don't work or cause unwanted side effects, other medications that may help include fluoxetine (Prozac, generic), losartan (Cozaar, generic), and niacin. Spreading a gel containing nitroglycerine on the hands may also help keep blood vessels open.

Biofeedback has been explored as a way to consciously redirect blood to the hands when an attack is underway, but the results haven't been overwhelmingly positive. Herbal remedies such as ginkgo and evening primrose oil have been tested, with iffy results. Other as-yet unproven treatments include low-level laser stimulation, sildenafil (Viagra), and acupuncture.

Severe Raynaud's requires more aggressive treatment. If an episode lasts long enough, it can kill tissue, causing an ulcer or even gangrene. Restoring blood flow sometimes requires hospitalization for intravenous medication or injections of an anesthetic into the wrist to block the nerves that trigger blood vessel constriction. For some people, a nerve-cutting operation called sympathectomy provides relief. - Harvard Heart Letter

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