Winter is Approaching: Raynaud’s Phenomenon
As winter is near and the colder weather is upon us, it is important to understand Raynaud’s Phenomenon (RP) as some may personally experience this condition or have a loved one that does.
What Causes Raynaud’s Phenomenon?
Raynaud’s Phenomenon occurs when blood vessels (most commonly those supplying the hands/fingers and toes) spasm in an exaggerated way in response to an external trigger. These triggers usually include cold temperatures and emotional stress. Normally, the blood vessels in the skin constrict in response to cool temperatures, thereby reducing heat loss and keeping the internal body core appropriately warm. In contrast, the blood vessels in the skin dilate in response to warm temperatures, thereby helping the body to eliminate heat and keeping the internal body core from becoming overheated. The sympathetic nervous system helps to regulate the constriction and dilation of the blood vessels not only in response to temperature changes but also with certain strong emotional stimuli. That is why some stressors may precipitate constriction of the blood vessels leading to similar symptoms we see in Raynaud’s Phenomenon in some individuals.
What Are The Symptoms of Raynaud’s Phenomenon?
In RP, there is an exaggerated response to cold temperatures or emotional stimuli because of abnormalities in the regulation of blood vessel vasoconstriction. RP is more than just “cold hands” and it leads to the characteristic color changes in the fingers and toes (also can be seen in the nose or ears in some cases):
First the fingers appear white from lack of blood flow to the skin because of altered severe vasoconstriction. When the vasoconstriction and blood vessel spasm lets up a bit, the fingers will appear as a blue-purplish hue as a decreased amount of blood flow returns. Then, as the blood vessel spasm resolves, the blood flows back to the skin causing the fingers to appear pink or red. Not everyone with RP has the classic tri-color change, but they usually have at least two. Discomfort and tingling in the affected areas are common symptoms.
The Two Types of Raynaud’s Phenomenon
There are two types of Raynaud’s Phenomena: Primary Raynaud’s (more common) and Secondary Raynaud’s. In Primary Raynaud’s, unlike Secondary Raynaud’s, there is no association with an underlying rheumatologic autoimmune disease. Performing a detailed physical exam with attention to examining the nail-fold capillaries of the fingers with a special magnifying glass, certain lab tests and a thorough history can help to distinguish each type. Obtaining a medication list is also important as certain medications may also precipitate RP symptoms.
How Do You Treat Raynaud’s Phenomenon?
First and foremost, keeping extremities and the core warm is very important. For some individuals, a trip to the grocery store (especially in the frozen section) can precipitate Raynaud’s Phenomenon so it is important to anticipate exposure to cold. Mittens are generally better in retaining heat in the hands than gloves.
Keeping feet dry is also important as moist regions can create a cool microclimate. Therefore, wearing cotton socks with wool socks as a second layer, or wearing smart wool socks rather than wool socks directly may help to avoid the foot from sweating and remain dry and warm.
Wearing layers on the chest and torso helps to keep the core warm, helping to dilate extremity blood vessels (and preventing constriction of blood vessels leading to RP flares).
Certain medications can be used to keep the blood vessels dilated, but these are usually reserved for Secondary Raynaud’s (or severe cases of Primary Raynaud’s).
Avoiding smoking which can sometimes contribute to vasoconstriction of vessels is also an important aspect in the treatment of RP.
Reynaud’s Phenomenon Conclusion
Most cases of Primary Raynaud’s Phenomenon and even Secondary Raynaud’s Phenomenon can be managed with lifestyle changes. However, in some cases of Secondary Raynaud’s complications can occur and patients may experience ulcerations at the tips of their fingers and toes or indentations in the skin at the digit tips from poor blood flow leading to slow wound healing. In severe cases, there can be gangrene of the fingertips or toes.
Keep warm this season and visit Magnolia Rheumatology in Westchester County if you are experiencing signs and symptoms of Raynaud’s Phenomenon so that we may be able to evaluate you and provide you with the best course of action to manage this condition!