Raynaud's Phenomenon is a vasospastic disorder of the small peripheral arteries called arterioles. This condition usually effects the fingers and toes but occasionally may effect other acral body parts such as the tongue or nose. The term Raynaud's Phenomenon refers to the vasospastic process that occurs. Raynaud's Disease refers to the condition.

The most common form of Raynaud's Disease is ideopathic primary Raynaud's Disease and is found in young women in 60-90% of the cases reported. Secondary Raynaud's Disease may be due to other connective or soft tissue disorders such as rheumatoid arthritis, systemic lupus or scleroderma. Occasionally, secondary Raynaud's Disease may be due to peripheral vascular occlusive disease, neurogenic lesions or drug intoxications.

The cause of Raynaud's Disease is unknown. Any condition or contributing factor that results in peripheral vasospasm may be considered a contributing cause of Raynaud's Phenomenon and Raynaud's Disease. Contributing conditions include anxiety, depression, rheumatoid arthritis, systemic lupus (SLE) and scleroderma. Contributing factors include cold exposure and nicotine. Raynaud's Disease is often seasonal and most active in the cold weather months. Exposure to cold air (air conditioning) during the summer can also initiate the onset of Raynaud's Phenomenon.

The picture to the left shows an interesting case of Raynaud's Disease that effects only the weight bearing surface of the digits. This 73 y/o patient described a 3 year history of sores on the bottom of her toes that began during the winter months and ended in spring with the onset of warm weather. The patient was not active and sat for long periods of time with her feet flat on the floor. The ischemic changes seen in the skin are specific to the weight bearing portions of her toes. This was caused by a combination of arterial vasospasm (Raynaud's Disease) and direct pressure to the skin by the floor that inhibited normal blood flow to the plantar surface of the digit. Treatment for this problem included limitation of cold exposure and elevating the feet to eliminate floor pressure against the toes.

Treatment of Raynaud's Phenomenon and Disease

Initial treatment consists of avoidance of any contributing factors to the condition such as cold exposure, emotional swings or smoking. Nicotine is a potent vasoconstrictor. Sedatives, mood stabilizers and psychological counseling may be helpful to control contributing factors such as stress and anxiety.

Visual imagery techniques are helpful for some patients. As an example;

Wendy has had problems with Raynaud's Disease for years. She is a mom and employed as a banker. On days where she is particularly busy, her fingers will blanch white and become cold. Wendy has found that she can control these symptoms by stopping everything that she is doing. She folds her hands in her lap and visualizes in her mind a beam of sunlight coming through a window focused on her hands. She feels the warmth of the sun on her hands. Wendy performs this exercise as needed. In addition to improving the temperature of her hands, she also notices a reduction in her stress level and tightness in her back.

Topical L-arginine cream can help warm hands and toes. L-arginine cream is a good prophylactic trick to pre-empt cold exposure and is handy for going outdoors in cold climates in winter. In-shoe warming devices are also helpful in this regard. Several oral medications are helpful in reducing peripheral vasospasm. Those medications include calcium channel blockers such as nifedipine (Calan/Verapamil) and prazosin. A surgical procedure performed by a neurosurgeon, called a sympathectomy, is reserved for the most severe cases of Raynaud's Disease.

Arteriole - a small artery.

Emboli - a term used to describe a blood clot.

Spider veins - see telangectasia.

Telangectasia - small, prominent surface capillaries and veins that are red or blue.

Venuole - a small vein.

In cases of primary Raynaud's Disease, the arterioles of the digits are anatomically and histologically normal. In advanced cases of Raynaud's Disease, the inner lining of the arteriole may thicken as a result of chronic vasospasm.

In secondary Raynaud's Disease, the pathology of the vessel may be a significantly altered by the secondary disease. Scleroderma, for example, results in thickening and hardening of connective tissue, resulting in an inadequate vascular response to hot and cold exposure.

No information is available for this topic.

The symptoms of Raynaud's Disease include intermittent attacks of vasospasm of the digits that results in loss of blood flow to the digit. Symptoms include blanching of the digit, paresthesia (tingling) and loss of color of the digit as blood flow to the digit is reduced. Color changes may be significant depending upon the degree of vasospasm. As the vasospasm is reduced, reactive hyperemia (excessive redness) may occur. Raynaud's attacks may last minutes to hours and depend upon the duration of the initiating cause such as cold exposure. Pain is not uncommon. Interestingly, Raynaud's phenomenon and disease rarely effect the thumb.

Many cases of Raynaud's Disease are precipitated by exposure to cold. Cold exposure is not only exposure to weather, but also exposure to air conditioner vents, drafts etc. Raynaud's phenomenon is common in the summer when a patient goes to a restaurant and is seated under the air conditioner vent.

Stress can also be considered a contributing factor to Raynaud's. Any emotional response that stimulates the sympathetic outflow or the release of catecholamines (stress, anger) may contribute to Raynaud's Disease.

No information is available for this topic.

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This article was written by Jeffrey A. Oster, DPM and last updated 4/16/10.  Additional references include;

The Merk Manual, 15th Edition. Merk Sharp and Dome Research Laboratories 1987