RAYNAUD’S PHENOMENON

TYPES

• Primary Raynaud’s disease has no known cause. It is a stand-alone disease with no other associated disorders. Most commonly go unnoticed, and some dismiss them as hypersensitivity to extremes of temperature. This subset has a strong correlation with women who are smokers
• Raynaud’s phenomenon- This subset occurs together with an underlying disease condition such as: 
  • Connective tissue disorders– systemic lupus erythematosus, rheumatoid arthritis, and Sjogren’s syndrome
  • Atherosclerosis or the accumulation of cholesterol plaques within the intima of the blood vessels
  • Carpal tunnel syndrome- impingement of the median nerve causes numbness of the affected hand
  • Injuries occurring due to excessive use of the hands and toes
  • Medications are taken: metoprolol, bisoprolol, antihypertensive medications, certain chemotherapeutic drugs
  • Smoking- accelerates arteriosclerosis

SYMPTOMS

Raynaud’s phenomenon can manifest as one of the following: 

• Cold extremities especially in the palmar and plantar digits
• Uneven color of the skin of the hands and feet especially during extremes of emotion such as fear, excitement, fight or flight situations
• Needle prick sensation of the extremities once the aggravating circumstance has been resolved
• Changes in the color of the affected limb or area of the body from white (pale) to reddish than pink when the blood flow is already restored.

DIAGNOSIS

On the initial visit to the clinician, a routine and thorough physical examination are done to elicit the response of the affected extremities.

Ancillary procedures such as testing for the anti-nuclear antibody can rule in the presence of autoimmune diseases that can aggravate the secondary type of Raynaud’s.

Acute-phase reactants such as erythrocyte sedimentation rate(ESR) is used to detect the presence of inflammatory and autoimmune disorders.

TREATMENT

To minimize the occurrence of the phenomenon, these are the following steps that can be taken:

• Wear thick clothing during the winter season, making sure that the areas of concern are covered before stepping outdoors
• Regulate the temperature of your vehicle so that the cold has dissipated before you go for a drive
• Avoidance of extremely cold places indoors. Make sure to set air conditioners to minimal temperatures to avoid getting cold. Also, use protective gloves or mittens when reaching out for food, especially in the freezer.

Medical treatments

• Use of drugs that causes vasodilation (enlargement of the blood vessels) can decrease the number of attacks
• Use of calcium channel blockers- this drugs causes the blood vessels to relax
• Surgical ablation of the sympathetic nerves of the hands to minimize their hyper-reactivity
• Injection of botulinum toxins on the affected area to block the impulses transmitted by the sympathetic nerves.