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Raynauds Phenomenonis a condition that affects the blood vessels in the extremities—generally, the fingers and toes. It is characterized by episodic attacks, called vasospastic attacks, in which the blood vessels in the fingers and toes constrict, usually in response to cold temperatures and/or emotional stress. When this condition occurs on its own, it is called primary Raynaud’s phenomenon. When it occurs with another condition such as scleroderma or lupus, it is called secondary Raynauds phenomenon.
Symptoms: There are intermittent attacks of white or blue in the fingers. In early attacks, only 1 or 2 fingertips may be affected. As it progresses, all the fingers may become involved. The thumbs are rarely affected.
During recovery there may be intense redness, throbbing, numbness, tingling, and slight swelling. Attacks usually terminate spontaneously or upon returning to a warm room or putting the hand in warm water. Between attacks there are no symptoms. The fingertips may develop ulcers that may heal during warm weather.
The causes of primary and secondary Raynauds phenomenon are unknown. Both abnormal nerve control of the blood vessel diameter and nerve sensitivity to cold exposure have been suspected as being contributing factors. The characteristic color changes of the digits are in part related to initial blood vessel narrowing due to spasm of the tiny muscles in the wall of the vessels, followed by sudden opening, as described above. The small arteries of the digits can have microscopic thickness of their inner lining, which also leads to abnormal narrowing of the blood vessels.
Management of Raynauds phenomenon involves protecting the fingers and the toes from cold, trauma, and infection. Medications that can aggravate blood vessel spasm should be avoided by patients with RP. In patients with persistent symptoms, medications that dilate the blood vessels can be administered.
Patients with Raynauds phenomenon who have no symptoms other than the color changes of extremities may require only measures to prevent complications. Prevention measures are important in primary and secondary RP regardless of the severity. Simple initial care involves keeping the body warm, especially the extremities. Warm clothing in colder environments is essential. Cotton gloves can be helpful while searching the freezer. Room temperatures should not be too cool. Rubber gloves protect the hands and prevent cooling while dish washing. Barefoot walking should be minimized. Compression of the blood vessels by tight-fitting wrist bands, rings, or footwear should be avoided.
Patients should guard their hands and feet from direct trauma and wounds. Any wounds or infections should be treated early to prevent more serious infections. Avoiding emotional stresses and tools that vibrate the hand may reduce the frequency of attacks. Biofeedback can also help to decrease the severity and frequency of RP in some patients.
Direct and indirect smoking should be avoided in patients with RP. The chemicals in tobacco smoke can cause blood vessel constriction and lead to hardening of the arteries, which can further impair oxygen supply to the extremities.
Care of the nails must be done carefully to avoid injuring sensitive toes and fingertips. Ulcers on the tips of the digits should be monitored closely by the doctor. These can become infected. Gently applied finger splints are used to protect ulcerated areas. Ointments that open the blood vessels (nitroglycerin ointment) are sometimes used on the sides of severely affected digits to allow increased blood supply and healing.
Medications that can aggravate symptoms of RP by leading to increased blood vessel spasm include over-the-counter cold and weight-control preparations, such as pseudoephedrine (Actifed, Chlor-Trimeton, Cotylenol, and Sudafed). "Beta-blockers," medicines used for high blood pressure and heart disease, can also worsen RP. These include atenolol (Tenormin), metoprolol (Lopressor), nadolol (Corgard), and propranolol (Inderal).
Patients with persistent or bothersome symptoms may be helped by taking oral medications that open (dilate) blood vessels. These include calcium antagonists, such as diltiazem (Cardizem, Dilacor), nicardipine (Cardene), nifedipine (Procardia), and other medicines used in blood pressure treatment, such as methyldopa (Aldomet) and prazocin (Minipress). Recent research has shown that the blood pressure drug losartan (Cozaar, Hyzaar) can reduce the severity of episodes of RP possibly more than nifedipine.
Medications that "thin" the blood, such as low doses of aspirin or dipyridamole (Persantine), are sometimes helpful.
Some patients with persistent symptoms can benefit by adding a medication called pentoxifylline (Trental) which makes the red blood cells more pliable, thereby improving circulation.
Severe RP can lead to gangrene and the loss of digits. In rare cases of severe disease, nerve surgery called "sympathectomy" is sometimes considered. In order to prevent blood vessel spasming, the nerves that stimulate the constriction of the vessels are surgically interrupted. Usually this is performed during an operation that is localized to the sides of the base of the fingers at the hand. Through small incisions the tiny nerves around the blood vessels are stripped away. This procedure is referred to as a digital sympathectomy.