Diseases & Conditions

Raynaud's disease

Raynaud's disease is a condition that causes some areas of your body — such as your fingers, toes, tip of your nose and your ears — to feel numb and cool in response to cold temperatures or stress. In Raynaud's disease, arteries that supply blood to your skin narrow, limiting blood circulation to affected areas.

Women are more likely to have Raynaud's disease. It's also more common in people who live in colder climates.

Treatment of Raynaud's disease depends on its severity and the presence of associated conditions. For most people, Raynaud's disease is more a nuisance than a disability.

Raynaud's disease is more than simply having cold hands and cold feet, and it's not the same as frostbite. Signs and symptoms of Raynaud's depend on the frequency, duration and severity of the blood vessel spasms that underlie the disorder. Signs and symptoms include:

• Sequence of color changes in your skin in response to cold or stress
• Numb, prickly feeling or stinging pain upon warming or relief of stress

During an attack of Raynaud's, affected areas of your skin usually turn white at first. Then, the areas often turn blue and feel cold and numb, and your sensory perception is dulled. As circulation improves, the affected areas may turn red, throb, tingle or swell. The order of the changes of color isn't the same for all people, and not everyone experiences all three colors.

Occasionally, an attack affects just one or two fingers or toes. Attacks don't necessarily always affect the same digits. Although Raynaud's most commonly affects your fingers and toes, the condition can also affect other areas of your body, such as your nose, lips, ears and even nipples. An attack may last less than a minute to several hours.

People who have Raynaud's accompanied by another disease will likely also have signs and symptoms related to their underlying condition.

If your doctor suspects Raynaud's, he or she will ask for a detailed description of your signs and symptoms.

Most doctors can diagnose Raynaud's directly from a description of your signs and symptoms. But it may be more difficult for them to identify whether you have Raynaud's alone or whether another disease, or some aspect of your lifestyle, is causing your symptoms.

Your doctor will also examine you to rule out other medical problems that may cause similar signs and symptoms, such as a pinched nerve. Your doctor may perform an in-office cold-simulation test. This test may involve placing your hands in cool water or exposing you to cold air, to invoke an episode of Raynaud's.

Sorting out primary vs. secondary Raynaud's
To distinguish between primary and secondary Raynaud's, your doctor may perform an in-office test called nail fold capillaroscopy. During the test, the doctor examines your nail fold — the skin at the base of your fingernail — under a microscope. Tiny blood vessels (capillaries) near the nail fold that are enlarged or deformed may indicate an underlying disease. However, some secondary diseases can't be detected by this test.

If your doctor suspects that another condition, such as an autoimmune or connective tissue disease, underlies Raynaud's, he or she may order blood tests, such as:

• Antinuclear antibodies (ANA) test. A positive test for the presence of these antibodies — produced by your immune system — indicates a stimulated immune system and is common in people who have connective tissue diseases or other autoimmune disorders.
• Erythrocyte sedimentation rate (ESR). This blood test determines the rate at which red blood cells settle to the bottom of a tube in the space of an hour. A faster than normal rate may signal an underlying inflammatory or autoimmune disease. Autoimmune diseases are commonly associated with secondary Raynaud's.

There's no single blood test to diagnose Raynaud's. Your doctor may order other tests, such as those that rule out diseases of the arteries, to help pinpoint a disease or condition that may be associated with Raynaud's.

If Raynaud's is severe — which is rare — blood circulation to your fingers or toes could permanently diminish, causing deformities of your fingers or toes.

If an artery to an affected area becomes blocked completely, sores (skin ulcers) or dead tissue (gangrene) may develop. Ulcers and gangrene can be difficult to treat.

See your doctor right away if you have a history of severe Raynaud's and develop an ulcer or infection in one of your affected fingers or toes.

Self-care and prevention steps usually are effective in dealing with mild symptoms of Raynaud's. If these aren't adequate, however, medications are available to treat more severe forms of the condition. The goals of treatment are to:

• Reduce the number and severity of attacks
• Prevent tissue damage
• Treat any underlying disease or condition

Medications
Depending on the cause of your symptoms, medications may prove effective at treating Raynaud's. To widen (dilate) blood vessels and promote circulation, your doctor may prescribe:

• Calcium channel blockers. These drugs relax and open up small blood vessels in your hands and feet. They decrease the frequency and severity of attacks in about two-thirds of people with Raynaud's. These drugs can also help heal skin ulcers on your fingers or toes. Examples include nifedipine (Adalat, Procardia), amlodipine (Norvasc), diltiazem (Cardizem, Dilacor), felodipine (Plendil), nisoldipine (Sular) and isradipine (DynaCirc Cr).
• Alpha blockers. Some people find relief with drugs called alpha blockers, which counteract the actions of norepinephrine, a hormone that constricts blood vessels. Examples include prazosin (Minipress) and doxazosin (Cardura).
• Vasodilators. Some doctors prescribe a vasodilator — a drug that relaxes blood vessels — such as nitroglycerin cream to your fingers to help heal skin ulcers.

You and your doctor may find that one drug works better for you than another. Some drugs used to treat Raynaud's have side effects that may require you to stop taking the medication. A drug may also lose effectiveness over time. Work with your doctor to find what works best for you.

Some medications actually can aggravate Raynaud's by leading to increased blood vessel spasm. Your doctor may recommend that you avoid taking:

• Certain over-the-counter (OTC) cold drugs. Examples include drugs that contain pseudoephedrine (Actifed, Chlor-Trimeton, Sudafed).
• Beta blockers. This class of drugs, used to treat high blood pressure and heart disease, includes metoprolol (Lopressor, Toprol), nadolol (Corgard) and propranolol (Inderal).
• Birth control pills. If you use birth control pills, you may wish to switch to another method of contraception because these drugs affect your circulation and may make you more prone to attacks.

If you have questions about how best to manage Raynaud's, contact your doctor. Your primary care doctor may refer you to a physician who specializes in treating Raynaud's.

Other treatments
Sometimes in cases of severe Raynaud's, approaches other than medications may be a treatment option:

• Nerve surgery. Nerves called sympathetic nerves in your hands and feet control the opening and narrowing of blood vessels in your skin. Sometimes it's necessary in cases of severe Raynaud's to cut these nerves to interrupt their exaggerated response. Through small incisions in the affected hands or feet, a doctor strips away these tiny nerves around the blood vessels. The surgery, called sympathectomy, may reduce the frequency and duration of attacks, but it's not always successful.
• Chemical injection. Doctors can inject chemicals to block sympathetic nerves in affected hands or feet. You may need to have the procedure repeated if symptoms return or persist.
• Amputation. Sometimes, doctors need to remove tissue damaged from a lack of blood supply. This may include amputating a finger or toe affected by Raynaud's in which the blood supply has been completely blocked and the tissue has developed gangrene. But this is rare.

Research
Scientists are evaluating the use of new drugs to treat Raynaud's. Some examples of drugs under study include the high blood pressure drug losartan (Cozaar), the erectile dysfunction medication sildenafil (Viagra), the antidepressant medication fluoxetine (Prozac), and a class of medication called prostaglandins.

A variety of steps can decrease Raynaud's attacks and help you feel better overall:

• Don't smoke. Nicotine in cigarettes causes skin temperature to drop by constricting blood vessels, which may lead to an attack. Inhaling secondhand smoke also may aggravate Raynaud's.
• Exercise. Your doctor may encourage you to exercise regularly, particularly if you have primary Raynaud's. Exercise can increase circulation, among other health benefits.
• Control stress. Because stress may trigger an attack, learning to recognize and avoid stressful situations may help control the number of attacks.
• Avoid caffeine. Caffeine causes your blood vessels to narrow and may increase the signs and symptoms of Raynaud's.
• Take care of your hands and feet. If you have Raynaud's, guard your hands and feet from injury. Don't walk barefoot. Take care of your nails to avoid injuring sensitive toes and fingertips. In addition, avoid wearing anything that compresses blood vessels in your hands or feet, such as tight wristbands, rings or footwear.
• Avoid workplace triggers. Avoiding tools that vibrate the hand may reduce the frequency of attacks.

During an attack: What should you do?
What should you do if you're experiencing an attack of Raynaud's? The first and most important action is to warm your hands or feet or any other affected areas of skin. The following steps can help you gently warm your fingers and toes:

• Move to a warmer area.
• Place your hands under your armpits.
• Wiggle your fingers and toes.
• Make wide circles, or windmills, with your arms.
• Run warm — but not hot — water over your fingers and toes.
• Massage your hands and feet.

If a stressful situation triggers an attack, you can help stop the attack by getting out of the stressful situation and relaxing. If you're trained in biofeedback, you can use this technique along with warming your hands or feet in water to help lessen the attack.