RAYNAUD’S PHENOMENON



Raynaud’s phenomenon involves bilateral pa­roxysmal ischemia of fingers or toes, usually pre­cipitated by cold and relieved by heat. The entire hand or foot is usually not affected. Raynaud’s phenomenon may be secondary to a variety of un­derlying diseases, including arterial occlusive diseases (e.g., arteriosclerosis obliterans or throm­boangiitis obliterans), connective tissue diseases (e.g., scleroderma, rheumatoid disease, systemic lupus erythematosus, or polyarteritis nodosa), trauma (e.g., air hammer operators or typists), var­ious neurologic diseases (e.g., multiple sclerosis or peripheral neuropathy), ingestion of certain drugs (e.g., ergotamine, methysergide, or beta-ad­renergic blocking drugs), nerve compression syndromes (e.g., thoracic outlet or carpal tunnel syndrome), hematologic abnormalities (e.g., cryoglobulinemia or cold agglutinins), and late after-cold injuries (e.g., frostbite or trench foot). The phenomenon probably occurs secondary to abnormalities of the sympathetic nerves, abnor­mal reactivity of the blood vessels, and/or sludg­ing of blood cells in the capillaries. If no under­lying disease can be found, the patient is said to have Raynaud’s disease. Raynaud’s disease affects women more frequently than men, most com­monly between the ages of puberty and 40.
At the time of an attack, the affected digit ini­tially turns white and subsequently becomes cy­anotic. Upon resumption of circulation, it may ap­pear hyperemic because of vasodilation. These changes are usually precipitated by exposure to cold but may also occur with emotional upset. In Raynaud’s disease the changes are usually bilat­eral. Between attacks, normal pulses are present, and the digits usually appear normal. In more se­vere cases “trophic” changes in the fingers or toes may occur consisting of smooth, shiny, tightly stretched skin over the digits (sclerodactyly) and nail changes. Small painful areas of gangrene may appear on the tips of digits and leave scars upon healing. Amputations of digits in patients with Raynaud’s disease are rare.

Mild cases should be treated by limitation of cold exposure. Smoking should be avoided. In more severe cases, vasodilating agents such as cal­cium-channel blocking agents may be used. Some patients may respond to regional sympathectomy. In Raynaud’s phenomenon treatment should be aimed at the underlying cause.