Raynaud’s phenomenon

Everyone has gone outside in the cold at one point without gloves and a scarf. For most people, this does not cause any major consequences. However, for those affected by Raynaud’s phenomenon, the repercussions are very different.

Raynaud's phenomenon

Do you know someone whose fingers become very white when they are exposed to the cold? This typical manifestation of Raynaud’s phenomenon is probably the most common. It is caused by the contraction or narrowing of very small blood vessels, called arterioles, which carry blood to the extremities and other parts of the body, including the:

  • fingers
  • toes
  • nose
  • lips, and
  • nipples

In medical terminology, the term “vasoconstriction” is used to refer to the narrowing of blood vessels. For individuals affected by Raynaud’s phenomenon, vasoconstriction is excessive and abnormally decreases blood circulation. It occurs especially during exposure to certain factors such as:

  • the cold
  • decreasing temperature variations, such as the transition into an air-conditioned room or into the frozen food section at the grocery store
  • stress, and
  • an emotional shock

Raynaud’s phenomenon affects between 3 and 5% of the adult population and up to 20% of young women. Its frequency can vary depending on the climate, skin colour, ethnic origin, and profession. The risk of having Raynaud’s phenomenon increases if a family member is affected by it.

Signs and symptoms of Raynaud’s phenomenon

The signs and symptoms of Raynaud’s phenomenon develop in three phases. First, significant paleness or whiteness of the affected part of the body is observed. Loss of sensitivity may be felt, and the skin becomes cold. Subsequently, a significant decrease in blood flow in the affected area causes cyanosis; a bluish discoloration of the skin. Next, the restoration of blood flow manifests itself by a reddening of the affected area about 15 to 20 minutes after the end of the exposure to the element which caused the attack.

Raynaud’s phenomenon can also cause:

  • pain
  • stinging
  • tingling, and
  • numbness

When they occur in the hands, attacks usually begin with the index finger, the middle finger, or the little finger, then spread to the other fingers. The thumb is rarely affected. Attacks can last from a few minutes to a few hours. When blood flow is significantly reduced, Raynaud’s phenomenon can cause serious complications, such as wounds that do not heal, and gangrene.

The causes of Raynaud’s phenomenon

There are two types of Raynaud’s phenomenon which have different causes. This distinction is important because it influences the proposed treatment option.

Primary Raynaud’s phenomenon or Raynaud’s disease, mostly affects people in good health. The first episode usually occurs before age 30. Complications are rare and periods of remission are common. Its cause is still unknown.

Secondary Raynaud’s phenomenon or Raynaud’s syndrome is caused by an undesirable effect of a drug or by a disease which causes a blood flow problem, such as:

  • scleroderma
  • lupus erythematosus
  • Sjögren’s syndrome
  • atherosclerosis, and
  • rheumatoid arthritis

Certain trades that require the use of tools that vibrate can also be the cause of Raynaud’s syndrome.

The signs and symptoms of Raynaud’s syndrome are the same as the ones previously described. However, they can be more severe and last longer.

Non-pharmacological measures

The first step of treatment of Raynaud’s phenomenon consists of implementing non-pharmacological measures, particularly focused on lifestyle changes. These measures may be sufficient to treat mild cases.

Here is some advice on the subject:

  • Quit smoking. Smoking causes blood vessels to narrow and is likely to bring on an attack. Pharmacists can recommend a pharmacological aid to help you quit smoking. They can also offer you their support as well as advice to help you succeed.
  • Reduce your caffeine intake (tea, coffee, and colas).
  • Avoid using medications which cause blood vessels to contract, such as decongestants and certain agents used to treat migraines or attention deficit disorder with or without hyperactivity (ADHD).
  • Always talk to your pharmacist before taking medication. He/she can guide you to some safe choices, especially when it comes to over-the-counter medication.
  • Learn to master certain relaxation techniques, especially if your attacks are caused by stress.
  • Avoid the cold. Wear warm gloves and socks when it is cold.
  • Dress in layers; wear several layers of clothing.
  • Avoid varying temperatures, such as the transition from a warm place to an air-conditioned one.
  • Limit the use of tools that cause vibrations.

When an attack occurs, soak the affected area of the body in warm water to help restore blood circulation. You can also place your fingers under your armpits or rub them together to warm them up.

Pharmacological measures

If, despite everything, the attacks are not under control using non-pharmacological measures, your doctor can prescribe medication. Some individuals will be able to take the medication only when needed during winter months; others, particularly those who are affected by a more severe Raynaud’s syndrome will have to take the medication regularly for a more stringent therapy. All therapies are intended to promote blood flow and prevent the excessive narrowing of blood vessels.

Your pharmacist can inform you about the medications prescribed to you to treat Raynaud's phenomenon, particularly about their effects, the precautions related to their administration, and their optimal use. Don't hesitate to talk to your pharmacist and ask as many questions as necessary. If you take other medications, he/she can determine if some of them can impact Raynaud's phenomenon. If so, a discussion between your pharmacist and your doctor may be necessary.

Although Raynaud's phenomenon was first described in 1862, it still holds its share of mysteries. New therapeutic options are being explored. Nonetheless, prevention still remains the best treatment.

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Raynaud’s phenomenon

Everyone has gone outside in the cold at one point without gloves and a scarf. For most people, this does not cause any major consequences. However, for those affected by Raynaud’s phenomenon, the repercussions are very different.
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