Raynaud's Phenomenon

Posted on: 02/09/2010

By Anatole Kleiner, M.D.

Wintertime brings cold weather, and with it come cold fingers and toes.  In individuals who experience Raynaud’s phenomenon, cold temperatures can also trigger a characteristic pattern of color changes.  Initially, the blood vessels that bring blood to the fingers spasm shut and the finger turns pale white, as blood ceases to flow to the tip of the finger.  As the spasm continues, the finger begins to look blue, which is a result of prolonged lack of blood flow.  Finally, as the spasm resolves and blood returns to the finger, it will turn red.  The whole episode may last from twenty minutes up to several hours.  Raynaud’s can be painful, and patients also can experience numbness or burning of the fingers.  Usually, an attack of Raynaud’s phenomenon will begin in a single finger, and then spread to the remaining digits of the hands.  In addition to the characteristic color changes of the fingers, some patients may also experience a generalized mottling of the skin, referred to as livedo reticularis.

Raynaud’s phenomenon was formally described in 1862 and is estimated to affect between 3% and 20% of the population.  While exposures to cold temperatures are an obvious trigger for Raynaud’s, it is probably the relative change in temperature that is more important.  For example, entering an air-conditioned house during a 90 degree day can cause an attack of Raynaud’s.  Emotional stress is also an important trigger.

Raynaud’s phenomenon can occur in otherwise healthy individuals.  When this happens, it is referred to as “Primary Raynaud’s.”  On the other hand, when Raynaud’s occurs in the setting of another associated illness, it is called “Secondary Raynaud’s.”  A number of different conditions have been described in association with Raynaud’s phenomenon, and these include scleroderma, systemic lupus erythematosus, and other systemic autoimmune diseases.  Raynaud’s has also been associated with more benign conditions, such as previous episodes of frostbite, or the use of vibrating tools.  Certain drugs have also been associated with Raynaud’s phenomenon, such as nicotine, amphetamines, beta-blockers, cocaine, and certain chemotherapy agents.

If an individual is experiencing color changes of the fingers suggestive of Raynaud’s phenomenon, a careful evaluation by their physician is warranted, to help confirm the diagnosis and also to screen for potential associated conditions or reversible causes.  It is important to distinguish primary Raynaud’s from secondary.  Features that might be suggestive of secondary Raynaud’s would include an age of onset of over 40 years old, male gender, thickening of the skin of the fingers, and formation of ulcers or black areas at the tips of the fingers as a result of a severe defect in circulation.  Treatment of Raynaud’s consists of education of the patient, emphasizing the need to keep the hands as well as the core body temperature warm.  Stress reduction can be very helpful.  Avoidance of nicotine or other drugs that can worsen Raynaud’s is essential.  If Raynaud’s attacks are persistent, or if Raynaud’s has caused damage to the tissues of the fingers because of severe restriction of circulation then certain medications can be used.  Treatment for any underlying conditions associated Raynaud’s phenomenon may also be necessary.

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