Raynaud Disease

Raynaud disease is a disorder that affects blood circulation, usually in the hands and feet. The arteries (blood vessels) that carry blood to your fingers, toes, ears, or nose tighten. This is often triggered by cold or emotional stress. The decrease in blood flow causes a lack of oxygen and changes in skin color. Over time, ulcers or gangrene (tissue death) may develop if frequent or severe attacks are not prevented.

What causes Raynaud disease?

  • Primary Raynaud: The cause of primary Raynaud disease is unknown. This form usually affects both hands and feet. It is more common and is often milder than secondary Raynaud. It often affects women and first appears before the age of 30.
  • Secondary Raynaud: This form is also known as Raynaud phenomenon. Nicotine, alcohol, caffeine, and exposure to certain chemicals, such as vinyl chloride, can increase your risk for secondary Raynaud. The following are some common causes:
    • Inflammatory and autoimmune diseases: Secondary Raynaud may be caused by certain diseases, such as scleroderma, lupus, Sjogren's syndrome, rheumatoid arthritis, and carpal tunnel syndrome.
    • Medicines or illegal drugs: Medicines used to treat high blood pressure, headaches, cancer, or colds may cause Raynaud disease. Use of illegal street drugs, such as amphetamines or cocaine, and some herbs may also cause Raynaud.
    • Trauma or injuries: Long-term use of vibrating tools, such as chain saws, grinders, or drills, may hurt nerves or blood vessels. Injuries to the hands or feet, such as a wrist fracture, surgery, or frostbite may also cause damage.

What are the signs and symptoms of Raynaud disease?

Your fingers or toes may first turn pale when you are exposed to cold or stressful situations. Due to the decrease in blood supply, your fingers or toes may then turn blue and may feel cold and numb. As blood supply returns to your fingers or toes, they become bright red. You may feel tingling, throbbing, or pain in your fingers or toes. Additional signs and symptoms may include the following:

  • Primary Raynaud: The color changes usually affect both hands or feet in the same way and at the same time. You may develop thick or tight skin and brittle nails over time. Signs and symptoms are usually mild.
  • Secondary Raynaud: The color changes usually do not affect both hands or feet in the same way or at the same time. You may develop thick or tight skin and brittle nails over time. You may also develop skin ulcers. Your skin may develop gangrene if your fingers or toes do not get enough blood for a long period of time. Signs and symptoms are generally more severe.

How is Raynaud disease diagnosed?

  • Nail fold capillary test: Your healthcare provider may put a drop of oil on your nail folds (skin at the base of the fingernail). The capillaries (tiny blood vessels) will then be checked under a microscope.
  • Blood tests: You may need blood taken to give healthcare providers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  • Angiography: This test looks for problems with your arteries in your hands, arms, feet, and legs. Before the x-ray, a dye is put into a thin tube through a small cut in your groin. The dye helps the arteries show up better on these x-ray pictures. Tell the healthcare provider if you have ever had an allergic reaction to contrast dye.
  • Arterial doppler: An arterial doppler test is done to check blood flow through an artery. A small metal disc with gel on it is placed on your skin over the artery. You can hear a "whooshing" sound when the blood is flowing through the artery. An "X" may be marked on your skin where healthcare providers feel or hear the blood flowing best. Healthcare providers may need to check blood flow more than once.
  • X-rays: Pictures of the bones, soft tissues, and other parts of your body may be taken. X-rays can show changes that will help healthcare providers learn if you have other diseases that may be causing Raynaud disease.

How is Raynaud disease treated?

Healthcare providers may tell you to avoid things or situations that could trigger an attack. If your daily activities are affected and symptoms are hard to control, you may need any of the following:

  • Medicines:
    • Alpha blockers: These medicines work by stopping a hormone that tightens blood vessels.
    • Antithrombotics: These are medicines that break apart clots and restore blood flow.
    • Calcium channel blockers: These medicines relax and open up small blood vessels in your hands and feet. They may also help heal skin ulcers on your fingers or toes.
    • Vasodilators: These medicines relax and widen the walls of the arteries. This may also help heal skin ulcers.
  • Surgery: A surgery called sympathectomy may be done to cut sympathetic nerves. Sympathetic nerves in your hands and feet control the opening and narrowing of blood vessels in your skin. Surgery may also need to be done if affected parts have developed gangrene.

What can I do to care for my skin if I have Raynaud disease?

  • Avoid putting too much pressure on your fingertips, such as typing or playing the piano. This kind of pressure may cause your blood vessels to narrow and trigger an attack.
  • Check your feet and hands daily for numb areas, thinning or thickening skin, black spots, cracks, brittle nails, or ulcers.
  • Keep your skin clean and dry to prevent an infection. Use lotion that contains lanolin on your hands and feet to keep the skin from drying or cracking.

What can I do to prevent a Raynaud disease attack?

  • Avoid cold temperatures when possible:Wear gloves, scarves, or other winter garments during the winter months or before you go into cold rooms.
  • Limit alcohol and caffeine: Men should limit alcohol to 2 drinks a day. Women should limit alcohol to 1 drink a day. A drink is 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor. Try drinking decaffeinated coffee, tea, or soda. Ask your healthcare provider for more information about alcohol and caffeine.
  • Use caution with medicines: Talk to your healthcare provider before you use medicines that may trigger an attack. These include certain medicines used for treating high blood pressure, headaches, cancer, or colds.
  • Exercise regularly: This prevents narrowing of the blood vessels and increases blood flow in your body.
  • Learn to manage stress: Stress may trigger an attack. Try new ways to relax, such as deep breathing, meditation, or biofeedback. Biofeedback is a way to control how your body reacts to stress or pain.
  • Stop smoking: If you smoke, it is never too late to quit. Smoking causes your blood vessels to narrow and may trigger an attack. Ask your healthcare provider for information if you need help quitting.

What should I do during a Raynaud disease attack?

  • Get inside to warm yourself.
  • Wiggle your fingers or toes, or swing your arms around to increase circulation. Massage the affected parts.
  • Place your hands under your armpits or run warm water over the affected area. Do notplace the affected part in direct contact with hot water or a hot water bottle. The affected parts may be injured if they are not able to feel that the water is hot.
  • Get yourself out of stressful situations if possible. Deep breathing, meditation, or biofeedback may help decrease stress.

Where can I find more information?

  • National Institute of Arthritis and Musculoskeletal and Skin Disease
    Information Clearinghouse
    National Institutes of Health
    1 AMS Circle
    Bethesda , MD 20892-3675
    Phone: 1- 301 - 495-4484
    Phone: 1- 877 - 226-4267
    Web Address: http://www.niams.nih.gov
  • National Heart, Lung and Blood Institute
    Health Information Center
    P.O. Box 30105
    Bethesda , MD 20824-0105
    Phone: 1- 301 - 592-8573
    Web Address: http://www.nhlbi.nih.gov/health/infoctr/index.htm

When should I contact my healthcare provider?

  • You have new symptoms since your last appointment.
  • Your symptoms prevent you from doing your daily activities.
  • You need help to quit smoking.
  • You have questions or concerns about your condition or care.

When should I seek immediate care?

  • You have many attacks even if you prevent cold, stress, or other triggers.
  • You have pain in your fingers or toes that does not go away or gets worse.
  • You have sores or ulcers on the tips of your fingers or toes that do not heal.
  • You have black spots on your fingers or toes.
  • Your hands or feet remain cold or discolored even after you warm them.