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Raynaud's disease
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Raynaud's disease

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HEART & BLOOD

Cardiovascular System

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

The aims of treatment are to reduce the number and severity of attacks and to prevent tissue damage. Doctors also want to treat any underlying disease or condition.

Medications
Depending on the cause of your symptoms, medications may prove effective at treating Raynaud's. To widen (dilate) blood vessels and promote circulation, your doctor may prescribe:

  • Calcium channel blockers. These drugs relax and open up small blood vessels in your hands and feet. They decrease the frequency and severity of attacks in about two-thirds of people with Raynaud's. These drugs can also help heal skin ulcers on your fingers or toes. Examples include nifedipine (Adalat, Procardia), diltiazem (Cardizem, Dilacor), amlodipine (Norvasc), verapamil (Calan, Isoptin) and nicardipine (Cardene).

  • Alpha blockers. Some people find relief with drugs called alpha blockers, which counteract the actions of norepinephrine, a hormone that constricts blood vessels. Examples include prazosin (Minipress) and doxazosin (Cardura).

  • Vasodilators. Some doctors prescribe a vasodilator — a drug that relaxes blood vessels — such as nitroglycerin cream. You apply the cream to your fingers to help heal skin ulcers.

  • Other medications. Some people with persistent symptoms may benefit by adding a medication called pentoxifylline (Trental), which improves circulation by making red blood cells more flexible as they pass through narrowed blood vessels.

You and your doctor may find that one drug works better for you than another. Often people with primary Raynaud's respond better to medications than do those with the secondary form.

Some drugs used to treat Raynaud's have side effects that may require you to stop taking the medication. A drug may also become less effective over time. Work with your doctor to find what works best for you.

Some medications actually can aggravate Raynaud's by leading to increased blood vessel spasm. Your doctor may recommend that you avoid taking:

  • Some over-the-counter (OTC) cold and diet drugs. Examples include drugs that contain pseudoephedrine (Actifed, Chlor-Trimeton, Sudafed) or phenylpropanolamine (PPA), a drug that has been widely used as a nasal decongestant and for weight control in some OTC medications.

  • Beta blockers. This class of drug, used to treat high blood pressure and heart disease, may worsen Raynaud's. Examples include metoprolol (Lopressor, Toprol), nadolol (Corgard) and propranolol (Betachron, Inderal).

  • Birth control pills. If you use birth control pills, switch to another method of contraception because these drugs affect your circulation and may make you more prone to attacks.

If you have questions about how best to manage Raynaud's, contact your doctor. Your primary care doctor may refer you to a physician who specializes in treating Raynaud's.

Other treatments
Sometimes in cases of severe Raynaud's, approaches other than medications may be a treatment option:

  • Nerve surgery. Nerves called sympathetic nerves in your hands and feet control the opening and narrowing of blood vessels in your skin. Sometimes it's necessary in cases of severe Raynaud's to cut these nerves to interrupt their exaggerated response as seen in Raynaud's. Through small incisions in the affected hands or feet, a doctor strips away these tiny nerves around the blood vessels. The surgery, called sympathectomy, may reduce the frequency and duration of attacks, but it's not always successful.

  • Chemical injection. Doctors can inject chemicals to block sympathetic nerves in affected hands or feet. You may need to have the procedure repeated if symptoms return or persist.

  • Amputation. Sometimes, doctors need to amputate a finger or toe affected by Raynaud's in which the blood supply has been completely blocked and the tissue has developed gangrene. But this is rare.

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
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Last Modified : 03/15/08 02:02 AM