Guide to Raynaud's Phenomenon

Raynaud's phenomenon is a disorder that affects the blood vessels in the fingers, toes, ears, and nose. This disorder is characterized by episodic attacks, called vasospastic attacks, that cause the blood vessels in the digits (fingers and toes) to constrict (narrow). Raynaud's phenomenon can occur on its own, or it can be secondary to other conditions.

Although estimates vary, recent surveys show that Raynaud's phenomenon may affect 5 to 10 percent of the general population in the United States. Women are more likely than men to have the disorder. Raynaud's phenomenon appears to be more common in people who live in colder climates. However, people with the disorder who live in milder climates may have more attacks during periods of colder weather.

For most people, an attack is usually triggered by exposure to cold or emotional stress. In general, attacks affect the fingers or toes but may affect the nose, lips, or ear lobes.

When a person is exposed to cold, the body's normal response is to slow the loss of heat and preserve its core temperature. To maintain this temperature, the blood vessels that control blood flow to the skin surface move blood from arteries near the surface to veins deeper in the body.

For people who have Raynaud's phenomenon, this normal body response is intensified by the sudden spasmodic contractions of the small blood vessels that supply blood to the fingers and toes. The arteries of the fingers and toes may also collapse. As a result, the blood supply to the extremities is greatly decreased, causing a reaction that includes skin discoloration and other changes.

Once the attack begins, a person may experience three phases of skin color changes (white, blue, and red) in the fingers or toes. The order of the changes of color is not the same for all people, and not everyone has all three colors.

Pallor (whiteness) may occur in response to spasm of the arterioles and the resulting collapse of the digital arteries.Cyanosis (blueness) may appear because the fingers or toes are not getting enough oxygen-rich blood.

The fingers or toes may also feel cold and numb. Finally, as the arterioles dilate and blood returns to the digits, redness may occur. As the attack ends, throbbing and tingling may occur in the fingers and toes. An attack can last from less than a minute to several hours.

Doctors classify Raynaud's phenomenon as either the primary or the secondary form. In medical literature, "primary Raynaud's phenomenon" may also be called:

Raynaud's diseaseidiopathic Raynaud's phenomenonprimary Raynaud's syndrome

The terms idiopathic and primary both mean that the cause is unknown.

Most people who have Raynaud's phenomenon have the primary form (the milder version). A person who has primary Raynaud's phenomenon has no underlying disease or associated medical problems. More women than men are affected, and approximately 75% of all cases are diagnosed in women who are between 15 and 40 years old.

Research shows that less than 10% of people who have only vasospastic attacks for several years, without involvement of other body systems or organs, rarely have or will develop a secondary disease later.

Although secondary Raynaud's phenomenon is less common than the primary form, it is often a more complex and serious disorder. Secondary means that patients have an underlying disease or condition that causes Raynaud's phenomenon. Connective tissue diseases are the most common cause of secondary Raynaud's phenomenon. Some of these diseases reduce blood flow to the digits by causing blood vessel walls to thicken and the vessels to constrict too easily. Raynaud's phenomenon is seen in patients with:

Raynaud's phenomenon also can occur in patients who have other connective tissue diseases, including:

Possible causes of secondary Raynaud's phenomenon, other than connective tissue diseases, are:

carpal tunnel syndromeobstructive arterial diseasesome drugs (such as beta-blockers, ergotamine preparations, certain chemotherapy agents)drugs that cause vasoconstriction (such as some over-the-counter cold medications and narcotics)people in certain occupations (such as workers exposed to vinyl chloride or workers who operate vibrating tools)

People with secondary Raynaud's phenomenon often experience associated medical problems. The more serious problems are skin ulcers or gangrene in the fingers or toes. Painful ulcers and gangrene are fairly common and can be difficult to treat. Weakness in the muscle of the esophagus may cause heartburn or difficulty in swallowing.

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