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Raynaud's disease
Raynaud's is a condition that causes some areas
of your body - such as your fingers, toes, tip of
your nose and your ears - to feel numb and cool in
response to cold temperatures or stress. It's a
disorder of the blood vessels that supply blood to
your skin. During a Raynaud's attack, these arteries
narrow, limiting blood circulation to affected
areas.
You can have Raynaud's without any underlying
disease associated with it, in which case it's
called Raynaud's disease or primary Raynaud's. Or it
can be part of another disease, in which case
doctors may refer to it as Raynaud's phenomenon or
secondary Raynaud's.
Women are more likely than men are to
have the disorder. It's more common in people who
live in colder climates.
Treatment of Raynaud's depends on its severity
and the presence or absence of associated
conditions. For most people, Raynaud's is more a
nuisance than a disability.
Signs and symptoms
Raynaud's is more than simply having cold hands and cold feet, and it's
not the same as frostbite. Signs and symptoms of Raynaud's depend on the
frequency, duration and severity of the blood vessel spasms that
underlie the disorder. Signs and symptoms include:
-
Sequence of color
changes in your skin in response to cold or stress
-
Numb, prickly
feeling or stinging pain upon warming or relief of stress
At first during an attack of Raynaud's, affected areas of your skin
usually turn white. Then, the areas often turn blue and feel cold and
numb, and your sensory perception is dull. The affected skin may look
slightly swollen. As circulation improves, the affected areas may turn
red, throb, tingle or swell. The order of the changes of color isn't the
same for all people, and not everyone experiences all three colors.
Occasionally, an attack affects just one or two fingers or toes. Attacks
don't necessarily always affect the same digits. Although Raynaud's most
commonly affects your fingers and toes, the condition also can affect
other areas of your body such as your nose, cheeks, ears and even
tongue. An attack may last less than a minute to several hours. Over
time, attacks may grow more severe.
People who have Raynaud's accompanied by another disease also may have
symptoms related to their underlying condition.
Causes
Doctors don't completely understand the cause of Raynaud's attacks, but
blood vessels in the hands and feet appear to overreact to cold
temperatures or stress.
When your body is exposed to cold temperatures, your extremities lose
heat. Your body slows down blood supply to your fingers and toes to
preserve your body's core temperature. Your body specifically reduces
blood flow by narrowing the small arteries under the skin of your
extremities. In people with Raynaud's, this normal response is
exaggerated. Stress causes a similar reaction to cold in the body, and
likewise the body's response may be exaggerated.
With Raynaud's, arteries to your fingers and toes go into what's called
vasospasm. This constricts the vessels, temporarily but dramatically
limiting blood supply. Over time, these same small arteries may also
thicken slightly, further limiting blood flow. The result is that
affected skin turns a pale and dusky color due to the lack of blood flow
to the area. Once the spasms subside and blood returns to the area, the
tissue may turn red before returning to a normal color.
Cold temperatures are most likely to provoke an attack. Exposure to cold
can be as simple as putting your hands under a faucet of running cold
water, taking something out of the freezer or exposure to cold air. For
some people, exposure to cold temperatures isn't necessary. Emotional
stress alone can cause an episode of Raynaud's.
Some researchers are studying whether Raynaud's may be partly an
inherited disorder.
Primary vs. secondary Raynaud's
Raynaud's occurs in two main types:
-
Primary
Raynaud's.
This is Raynaud's without an underlying disease or associated
medical problem that could provoke vasospasm. Also called Raynaud's
disease, it's the most common form of the disorder. Primary
Raynaud's typically affects both hands and both feet.
-
Secondary
Raynaud's.
This is Raynaud's caused by an underlying problem. Also called
Raynaud's phenomenon, secondary Raynaud's usually affects both of
your hands or both feet. Although secondary Raynaud's is less common
than the primary form, it's often a more complex and serious
disorder.
Causes of secondary Raynaud's include:
-
Scleroderma.
Raynaud's phenomenon occurs in about 90 percent of people who have
scleroderma — a rare disease that leads to hardening and scarring of
the skin. Scleroderma, a type of connective tissue disease, results
in Raynaud's because the disease reduces blood flow to the
extremities. It causes tiny blood vessels in the hands and feet to
thicken and to constrict too easily, promoting Raynaud's.
-
Lupus.
About one-third of Americans with lupus — an autoimmune disease that
can affect many parts of your body, including your skin, joints,
organs and blood vessels — develop Raynaud's. An autoimmune disease
is one in which your immune system attacks healthy tissue.
-
Rheumatoid
arthritis.
Raynaud's may be an initial sign of rheumatoid arthritis — an
inflammatory condition causing pain and stiffness in the joints,
often including the hands and feet.
-
Sjogren's
syndrome.
Raynaud's phenomenon can also occur in people who have Sjogren's
syndrome — a rare disorder that often accompanies scleroderma, lupus
or rheumatoid arthritis. The hallmark of Sjogren's syndrome, a
connective tissue disease, is chronic dryness of the eyes and mouth.
-
Diseases of the
arteries.
Raynaud's phenomenon can be associated with various diseases that
affect arteries, such as atherosclerosis — the gradual buildup of
plaques in blood vessels that feed the heart (coronary arteries), or Buerger's disease — a disorder in which the blood vessels of the
hands and feet become inflamed.
-
Carpal tunnel
syndrome.
The carpal tunnel is a narrow passageway in your wrist that protects
a major nerve to your hand. Carpal tunnel syndrome is a condition in
which pressure is put on this nerve, producing numbness and pain in
the affected hand. The affected hand may become more susceptible to
cold temperatures and episodes of Raynaud's.
-
Repetitive
trauma.
Raynaud's can also be caused by repetitive trauma that damages
nerves serving blood vessels in the hands and feet. In fact, nerve
damage is thought to play a role in many cases of Raynaud's. Some
people who type or play the piano for long periods of time or
vigorously may be susceptible to Raynaud's. Workers who operate
vibrating tools can develop a type of Raynaud's phenomenon called
vibration-induced white finger.
-
Smoking.
Smoking constricts blood vessels and is a potential cause of
Raynaud's.
-
Injuries.
Prior injuries to the hands or feet, such as wrist fracture,
surgery, or frostbite, can lead to Raynaud's phenomenon.
-
Certain
medications.
Some drugs — including beta blockers, which are used to treat high
blood pressure; migraine medications that contain ergotamine;
estrogen replacement therapy; certain chemotherapy agents; and drugs
that cause blood vessels to narrow, such as some over-the-counter
cold medications — have been linked to Raynaud's.
-
Chemical
exposure.
Some workers in the plastics industry who are exposed to vinyl
chloride develop an illness similar to scleroderma. Raynaud's can be
a part of that illness.
-
Other causes.
Raynaud's has also been linked to an overactive thyroid gland
(hyperthyroidism), to a condition in which blood pressure rises in
the blood vessels of the lungs (pulmonary hypertension) and, rarely,
to certain cancers.
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