Medical Edge Newspaper Column

What is Raynaud's Disease and How Do I Manage It?

November 18, 2007
Dear Mayo Clinic:
I'm very susceptible to cold, and recently I've been diagnosed with Raynaud's disease. Why did I get this, and how should I take care of it?

Answer:
Raynaud's (ray-NODES) disease is a fairly common condition in which small blood vessels, usually in the fingers or toes, develop an exaggerated sensitivity to cold.

Exposure to cold normally slows blood flow to your extremities (for example, the hands and feet) as your body focuses on keeping the inner organs warm. For people with Raynaud's disease, the small arteries constrict dramatically, which reduces blood flow, most often in the fingers and toes, but the nose, ears and cheeks also can be affected. The constriction, called vasospasm, can last for a little as a minute or as long as several hours. Stressful emotions can trigger vasospasm, too, as the body releases the hormone adrenalin, which constricts blood vessels.

The cause of most cases of Raynaud's is unknown. In some instances, it can be an occupational hazard for workers who operate tools that vibrate, such as a wood sander or chainsaw. And repetitive trauma to the hand can contribute to the development of arterial disease, which may lead to vasospasm. Raynaud's also can be the result of exposure to industrial chemicals, such as those used in the plastics industry, or related to the use of some medications for migraine headache or high blood pressure.

For some patients, an underlying health problem, such as diabetes, scleroderma or rheumatoid arthritis, is the culprit. In these instances, the condition is related to persistent narrowing (instead of temporary constriction) of the small arteries in the extremities. In this situation it is called secondary Raynaud's or Raynaud's phenomenon instead of Raynaud's disease.

In both cases, the signs and symptoms are the same — when exposed to cold, the skin turns white, reflecting limited blood flow. Upon warming, the affected skin may turn blue, followed by red. The fingers or toes may look slightly swollen, and pain or numbness may occur. In rare instances of severe Raynaud's, prolonged or repeated episodes can lead to skin damage, such as peeling or sores.

Raynaud's disease often first occurs between ages 15 and 40. It affects only a small percentage of Americans, women more often than men, and it's more common in people who live in colder climates.

There's no cure for Raynaud's, but most people can manage the disease with lifestyle changes. You should dress to avoid exposure to cold. For example, wear mittens instead of gloves in the winter to keep your fingers warmer. Exercise to increase your circulation. Don't use tobacco (nicotine constricts blood vessels), and avoid injuring your hands and feet. Learn to manage or avoid stressful situations whenever possible. In addition, consult with your doctor about medications that may trigger attacks. These include over-the-counter cold or allergy remedies, birth control pills, headache medicines and beta-blockers.

In many cases, Raynaud's doesn't cause any permanent damage. In severe cases, it's important to manage any underlying medical condition and seek medical treatment to prevent sores and tissue damage. Medications that relax blood vessels and promote circulation can help reduce symptoms and prevent tissue damage.

— Roger Shepherd, M.D., Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.