Raynaud's phenomenon (pron.

: /reɪˈnoʊz/) is a vasospastic disorder causing

discoloration of the fingers, toes, and occasionally other areas. This condition may
also cause nails to become brittle with longitudinal ridges

• Raynaud's disease is a rare disorder of the blood vessels, usually in the

fingers and toes. It causes the blood vessels to narrow when an individual is
cold or feeling stressed.

• When this happens, blood can't get to the surface of the skin and the
affected areas turn white and blue. When the blood flow returns, the skin
turns red and throbs or tingles.

• In severe cases, loss of blood flow can cause sores or tissue death.

Raynaud's phenomenon includes

 Raynaud's disease (also known as "Primary Raynaud's phenomenon")

where the phenomenon is idiopathic, and
 Raynaud's syndrome (secondary Raynaud's), where it is caused by some
other instigating factor, most commonly connective tissue disorders such
as systemic lupus erythematosus

Measurement of hand-temperature gradients is one tool used to

distinguish between the primary and secondary forms. Primary
Raynaud's (disease)

INCIDENCE
3-12.5% of men and 6-20% of women report symptoms of
Raynaud’s phenomenon. The average age of onset is lower in
women than in men, and prevalence is higher in colder climates.
Family history, oestrogen exposure, and emotional stress are
commonly associated with the phenomenon in women, whereas
smoking and hand arm vibration syndrome (HAVS) are more
commonly implicated in men

CAUSES
Raynaud's disease, or "Primary Raynaud's", is diagnosed if the symptoms
are idiopathic, that is, if they occur by themselves and not in association with other
diseases.
 Some refer to Primary Raynaud's disease as "being allergic to coldness." It
often develops in young women in their teens and early adulthood.
 Primary Raynaud's is thought to be at least partly hereditary, although
specific genes have not yet been identified.
 Smoking worsens frequency and intensity of attacks, and there is a
hormonal component.
 Caffeine also worsens the attacks. Sufferers are more likely to
have migraine and angina than controls.
Secondary Raynaud's (syndrome) [edit]
Raynaud's syndrome, or "Secondary Raynaud's," occurs secondary to a wide
variety of other conditions. Secondary Raynaud's has a number of associations:

 Connective tissue disorders:

[7]
 scleroderma
 systemic lupus erythematosus
 rheumatoid arthritis
 Sjögren's syndrome
 dermatomyositis
 polymyositis
 mixed connective tissue disease
 cold agglutinin disease
 Ehlers-Danlos Syndrome
 Eating disorders
 anorexia nervosa
 Obstructive disorders
 atherosclerosis
 Buerger's disease
 Takayasu's arteritis
 subclavian aneurysms
 thoracic outlet syndrome
 Drugs
 Beta-blockers
 cytotoxic drugs - particularly chemotherapeutics and most
especially bleomycin
 ciclosporin
 Bromocriptine
 ergotamine
 sulfasalazine
 anthrax vaccines whose primary ingredient is the Anthrax Protective
Antigen
 Occupation
 jobs involving vibration, particularly drilling, suffer from vibration white
finger
 exposure to vinyl chloride, mercury
 exposure to the cold (e.g. by working as a frozen food packer)
 Others
 Physical Trauma, such as that sustained in auto accident or other traumatic
events
 Lyme Disease
 hypothyroidism
 cryoglobulinemia
 malignancy
 reflex sympathetic dystrophy
 carpal tunnel syndrome
 Magnesium Deficiency
 Multiple Sclerosis
Erythromelalgia (the opposite of Raynaud's, with hot and warm extremities)
often co-exists in patients with Raynaud's
PATHOPHYSIOLOGY
cold or emotional stress

exaggeration of vasomotor responses .

More specifically, it is a hyperactivation of the sympathetic nervous system

extreme vasoconstriction of the peripheral blood vessels,

leading to tissue hypoxia.

Chronic, recurrent cases of Raynaud phenomenon

atrophy of the skin, subcutaneous tissues, and muscle.

In rare cases

ulceration and ischemic gangrene

Symptoms
The condition can cause
 pain within the affected extremities,
 discoloration (paleness),
  sensations of cold and/or numbness.
If someone with Raynaud's is placed in too cold a climate, it could potentially
become dangerous.

1. When exposed to cold temperatures, the blood supply to the fingers or toes,
and in some cases the nose or earlobes, is markedly reduced; the skin turns
pale or white (called pallor), and becomes cold and numb.

2. When the oxygen supply is depleted, cyanosis results

 3. These events are episodic, and when the episode subsides or the area is
warmed, the blood flow returns and the skin colour first turns red (rubor),
and then back to normal, often accompanied by swelling, tingling, and a

painful "pins and needles" sensation.

4. In pregnancy, this sign normally disappears owing to increased surface
blood flow.
5. Raynaud's also has occurred in breastfeeding mothers, causing nipples to
turn white and become extremely painful

DIAGNOSTIC FINDINGS

 History collection
 Physical examination.

 Digital artery pressure: pressures are measured in the arteries of the fingers
before and after the hands have been cooled. A decrease of at least 15 mmHg is
diagnostic (positive).
 Doppler ultrasound: to assess blood flow.
 Full blood count: this may reveal a normocytic anaemia suggesting the anaemia
of chronic disease or renal failure.
 Blood test for urea and electrolytes: this may reveal renal impairment.
 Thyroid function tests: this may reveal hypothyroidism.
 An autoantibody screen, tests for rheumatoid factor, Erythrocyte sedimentation
rate, and C-reactive protein, which may reveal specific causative illnesses or a
generalised inflammatory process.
 Nail fold vasculature: this can be examined under the microscope.
Treatment [edit]
Treatment options are dependent on the type of Raynaud's present. Raynaud's
syndrome is treated primarily by addressing the underlying cause but includes all
options for Raynaud's disease as well. Treatment of primary Raynaud's focuses on
avoiding triggers.

GENERAL CARE

 Environmental triggers should be avoided, e.g. cold, vibration, etc.

 Emotional stress is another recognized trigger.
 Extremities should be kept warm (wear extra socks or gloves if needed)
 Consumption of caffeine and other stimulants and vasoconstrictors must be prevented.
Emergency measures

 If white finger (Raynaud's) occurs unexpectedly and a source of warm water is available,
allow tepid to slightly warm water to run over the affected digits while you gently massage
the area. Continue this process until the white area returns to its normal, healthy color.
 If triggered by exposure in a cold environment and no warm water is available, place the
affected digits in a body cavity—armpit, crotch, or even the mouth. Keep the affected area
warm at least until the whiteness returns to its normal, healthy color. Get out of the cold as
soon as possible.
 "windmilling" the arms (swinging them in large circles) reasonably quickly to force the
blood to the hands and fingers. This can cause dizziness, so it should be attempted only for a
short time before stopping for a minute and subsequently continuing.
 A less effective (but less conspicuous) variation is to swing the arms back and forth in a part
of a circle to achieve the same results. This variation does take longer, though, and requires
swifter movement of the arms, so it is advised to use the first variation if possible.
Drug therapy

 calcium channel blockers (nifedipine) or diltiazemCalcium channel blockers can be helpful

for the treatment of Raynaud's phenomenon.[13]
 Angiotensin II receptor antagonists --- Losartan
 sildenafil (Viagra) improved both microcirculation and symptoms in patients with secondary
Raynaud's phenomenon resistant to vasodilatory therapy.
 Fluoxetine, a selective serotonin reuptake inhibitor, and
 other antidepressant medications may reduce the frequency and severity of episodes if
caused mainly by psychological stress.
 RayVa is a topical cream for the treatment of Raynaud's phenomenon. It
contains prostaglandin E1 as the active ingredient and a permeation enhancer DDAIP which
facilitates the delivery of the drug into the blood stream.

SURGICAL INTERVENTION

 In severe cases, a sympathectomy . The nerves that signal the blood vessels of the fingertips
to constrict are surgically cut.
 Microvascular surgery of the affected areas is another possible therapy.
 Infusions of prostaglandins, e.g. prostacyclin, may be tried, with amputation in
exceptionally severe cases.
 A more recent treatment for severe Raynaud's is the use of Botox.

Alternative and experimental (research) approaches

 The extract of the Ginkgo biloba leaves (Egb 761, 80 mg) may reduce frequency of attacks.
 Two separate gels combined on the fingertip (somewhat like two-part epoxy, they cannot be
combined before use because they will react), increased blood flow in the fingertips by about
three times. One gel contained 5% sodium nitrite and the other contained 5% ascorbic acid.
The milliliter of combined gel covered an area of ~3 cm². The gel was wiped off after a few
seconds.
 Piracetam, a nootropic drug, can be useful as a long-term treatment for vasospastic disorders.
 Arginine is a precursor for the synthesis of nitric oxide, which is a powerful vasodilator.
 Milder cases of Raynaud's can often be addressed by biofeedback or other techniques to help
control involuntary body functions like skin temperature.
 Fish oil supplements which contain long-chain omega-3 fatty acids may help to control
symptoms of primary Raynaud's.
 Vitamin D is also shown to be helpful in improving the symptoms of Raynaud's phenomenon