Raynaud’s phenomenon is a medical condition which causes discoloration of the fingers, toes, and occasionly in other areas and it is brought about by the extreme vasoconstriction of the peripheral blood vessels,causing tissue hypoxia.This phenomenon is named after the french physician Maurice Raynaud.The picture given below gives a general picture of the disorder. The condition also causes nails to become brittle and leads to the development of longitudinal ridges on them.The two conditions which cause or evoke the disorder are emotional factors and cold/heat.
TYPES OF RP AND CAUSES
Raynaud’s phenomenon(RP) is further classified as Primary Raynaud’s phenomenon or Raynaud’s disease, and Secondary Raynaud’s or Raynaud’s syndrome.When RP occurs alone it is called Raynaud’s disease or Primary RP. and when it occurs in conjunction with other diseases it is called Secondary RP.Now the question arises..what causes Primary and Secondary RP?The answer is the actual cause for both is unknown.However the main suspected reasons are abnormal nerve control of blood vessel diameter and nerve sensitivity to cold exposure.Skin discoloration occurs because a sudden vasoconsricction of the peripheral blood vessels causes a decreased blood supply to the local tissues.First the digits become white due to the decrease in blood supply, then they turn blue due to tissue hypoxia or lack of oxygen for a prolonged period.Later the blood vessels reopen which causes a sudden “flushing” phenomenon causing the digits to become red in color.This three phase color change(white to blue to red) is characteristic of RP.
COMPLICATION AND RISK FACTORS
This condition affects women more frequently than men,specially in their second, third, and fourth decades of life.The conditions along which RP is seen includes rheumatic diseases(scleroderma, systemic lupus erythematosus,rheumatoid arthritis,etc.),thoracic outlet syndrome, hormone imbalance(eg.hypothyroidism),trauma(eg.frostbite),medications(propanolol,ergotamine,etc.),nicotine, and even rarely with cancers like myxoma.
In mild forms only the color change is characteristic with mild tingling or numbness of the affected digits.When the vasospasms are severe,tissue hypoxia can cause pain as the sensory nerves get irritated.In rare cases continued vasospasms cause ulceration of the digits because of the severe oxygen depletion.If the oxygen supply remains cut for long, gangrene may set in.Some areas like ears, nose, and tongue can get affected in rare cases.But ulcerations are few in such cases.
In patients with secondary RP,symptoms related to their underlying disease can occur.Patients with scleroderma develop RP as their primary symptom in 70% of the cases.
DIAGNOSIS AND TESTS
Diagnosis is easy for patients with the three phase characteristic color change.Using a magnifying instrument certain vasscular changes in capillaries adjacent to fingernails can be diagnosed.Blood test for rheumatiod diseases, autoimmune diseases, and thyroid disorders can detect secondary diseases that cause RP.Certain tests for patient’s extremities are done to find diseases that mimic RP, as in thoracic outlet syndrome.
Protection of fingers and extremities from cold, trauma, and infection is the main measure to be taken.Patients with RP should avoid medications that increase vasospasms.In severe cases of RP, medications to dilate blood vessels can be given.
Some preventive measures and lifestyle changes are:
- Keep the extremities warm specially in cold climate.
- Use rubber gloves to wash clothes or dishes.
- Cotton gloves can be used while putting hands in freezer.
- Avoid walking barefoot.
- Avoid emotional stress.
- Guard extemities from trauma or injuries.
- Any injury should be treated as soon as possible.
- Smoking should be strictly stopped.
- Certain medications like beta-blockers and pseudoephedrine that aggravate RP should not be used.
Scientists have reported a genetic link for RP.Also they are trying to develop a gel which release nitric oxide at the affected site.This is believed to dilate the blood vessels.Therefore a complete solution for RP is not a distant goal.