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Raynaud Phenomenon
Raynaud phenomenon (RP) is a common condition in which there is vasospasm
(blood vessel constriction) of the fingers, toes, nose, and/or ears.
RP is triggered by cold temperatures or emotional stress and happens
more often among women. There is reduced blood flow to the fingers
and toes (the “digits”). Primary RP occurs on its own without an associated medical reason. Secondary RP occurs because of an underlying
medical condition, such as autoimmune diseases, physical abnormalities (such as an extra rib that squeezes the blood vessels in the arms),
environmental causes, blood disorders, and certain medications.
Symptoms of Raynaud Phenomenon
Loss of blood flow
causes the affected
areas to first appear
pale and white...
Vasospasm
(blood vessel
constriction)
Symptoms
Both primary and secondary RP cause skin discoloration in the digits, which first turn pale and white. They then turn blue or dusky because of the decreased oxygen supply, followed by red once the
blood flow returns. This can be painful or cause numbness, tingling, or throbbing.
Primary and secondary RP can usually be distinguished by their
symptoms. While primary RP often occurs in people younger than
30 years and causes minimal pain, secondary RP occurs in people
who are 30 years or older and is more painful. Primary RP is much
more common. Secondary RP can have a more severe course that
sometimes leads to skin sores and even gangrene (tissue death).
then blue or dusky
from a lack of
oxygen supply...
then red once
blood flow returns.
Blood flow
restored
Diagnosis
Your doctor will ask you about your symptoms, look at your fingers
and toes, and may use a magnifying tool called a dermoscope to look
at the blood vessels surrounding your nails. Your doctor may also
take blood tests to look for evidence of an underlying disease.
Your doctor may use
a dermoscope to look
at the blood vessels
surrounding your nails.
Treatment
Treatment of RP depends on the severity of the symptoms and the
presence of underlying disease. Primary RP is not usually harmful
and is therefore managed with lifestyle modifications, which include avoiding cold exposure (keeping the whole body warm is important), protecting and insulating the skin in cold climates, quitting smoking, stopping medications that cause blood vessel
constriction, avoiding caffeine, and exercises to improve blood flow
to the digits (such as swinging the arm with the arm straight out).
Secondary RP often requires medications that specifically treat
the underlying condition. Depending on the cause of the RP, your
doctor may also prescribe topical or oral medications that enhance
blood flow to affected areas. Alternate therapies are available for difficult cases.
Authors: Emily C. Milam, BA; Sarika M. Ramachandran, MD; Andrew G. Franks Jr, MD
Conflict of Interest Disclosures: None reported.
Section Editor: Misha Rosenbach, MD
1400
FOR MORE INFORMATION
• Raynaud’s Association
http://www.raynauds.org
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JAMA Dermatology December 2015 Volume 151, Number 12 (Reprinted)
Copyright 2015 American Medical Association. All rights reserved.
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