What are the other Names for this Condition? (Also known as/Synonyms)

• Medication-Induced Raynaud Phenomenon

What is Drug-Induced Raynaud Phenomenon? (Definition/Background Information)

• Raynaud phenomenon is a condition wherein there is abnormal constriction of the arteries causing episodes of decreased blood flow in the body. The condition is believed to arise  due to the abnormal and periodic narrowing of the small blood vessels in the hands and feet
• Drug-Induced Raynaud Phenomenon occurs secondary to the use of certain medication, as an adverse reaction of the body. The medications causing the condition include certain chemotherapy drugs, vaccines, over-the-counter prescriptions, and beta-blockers
• Drug-Induced Raynaud Phenomenon can present with pale areas on the fingers and hands, which then turn bluish, and subsequently red, due to blood flowing variably to the skin area. This can result in burning sensation, inflammation, itching, and pain
• Stopping or discontinuing the use of such medications may decrease progression of Drug-Induced Raynaud Phenomenon and/or may result in resolution of the condition. The prognosis is good in a majority of cases with adequate treatment

Who gets Drug-Induced Raynaud Phenomenon? (Age and Sex Distribution)

• Drug-Induced Raynaud Phenomenon may affect individuals of any age group, since the condition is caused by the use of medications
• Both males and females are affected
• No racial or ethnic group predilection is observed and the condition is observed worldwide

What are the Risk Factors for Drug-Induced Raynaud Phenomenon? (Predisposing Factors)

The key risk factor for Drug-Induced Raynaud Phenomenon is the use of certain medications that cause the condition as a side effect. The medications observed to induce this abnormal skin condition may include:

• ADHD stimulant medication
• Anthrax vaccine
• Beta blocker medications
• Certain antibiotics and decongestants
• Chemotherapy agents including bleomycin
• Dopamine agonists
• Immunosuppressants such as cyclosporin
• Medication used to treat inflammatory bowel disorders
• Medications used to treat migraine such as ergotamine

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Drug-Induced Raynaud Phenomenon? (Etiology)

Raynaud phenomenon is a benign condition that occurs due to the abnormal and episodic narrowing of arteries, resulting in decreased blood flow to the fingers and toes. When factors leading to the causation of the condition are known, it is called secondary Raynaud phenomenon.

• Drug-Induced Raynaud Phenomenon develops from the use of certain medications/drugs that are used for various health conditions.
• It is believed that the offending drug potentially causes an abnormal cell-mediated immune response in the body
• Sometimes, the appearance of signs and symptoms due to the drug may not be observed immediately after starting the medication. The condition may arise after a period of time

What are the Signs and Symptoms of Drug-Induced Raynaud Phenomenon?

The signs and symptoms of Drug-Induced Raynaud Phenomenon may vary from one individual to another. It may also be mild or severe and may be related to the type and usage of the drug. The signs and symptoms may include:

• Initially, there is decrease in blood flow resulting in pale areas, which may be associated with pain or numbness
• Bluish to purple discoloration may be observed from a lack of oxygen to the region/skin
• Subsequently, the blood vessels dilate in the affected region resulting in increased blood flow causing redness, burning sensation, pain, itching, tingling sensation, and swelling
• Usually such episodes are triggered by exposure to cold, and such episodes can last from several minutes to several hours
• The condition usually affects the fingers, hands, feet, and toes. Occasionally, it can affect parts of the face such as the ears, lips, and nose
• Occasionally, it can affect the nipples in breastfeeding mothers, resulting in a very painful condition

The onset of Drug-Induced Raynaud Phenomenon may be slow or rapid. In some cases, it may not be immediately observed, but may take days and weeks to manifest. In some cases, it may even take much longer.

How is Drug-Induced Raynaud Phenomenon Diagnosed?

Drug-Induced Raynaud Phenomenon may be diagnosed using the following tests and exams:

• Complete physical examination with comprehensive evaluation of medical history (which includes the use of any drug/medication). The condition is known to get better after stoppage of the offending medication
• Assessment of the signs and symptoms
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation

Skin biopsy is usually not necessary in many cases; however, if required a skin biopsy may be undertaken. Also, in a majority of individuals, no elaborate testing is needed, apart from examination of the clinical signs and symptoms.

In the case of secondary Raynaud phenomenon, diagnosis of underlying conditions resulting in Raynaud phenomenon is often necessary. In such cases, the following tests may be performed:

• Complete blood count (CBC)
• Serum electrolyte levels
• C-reactive protein levels test
• Erythrocyte sedimentation ratio (ESR) levels test
• Rheumatoid factor levels blood test
• Urine analysis
• Thyroid function test
• Kidney function test
• Doppler ultrasound studies to determine blood flow
• Radiographic studies of the affected region, if needed
• Pulse oximetry, to determine the level of oxygen in blood
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Drug-Induced Raynaud Phenomenon?

The following complications may be noted from Drug-Induced Raynaud Phenomenon:

• Cosmetic issues resulting in emotional stress
• Secondary bacterial and fungal infection due to scratching, bleeding, and ulceration
• Complications arising from an underlying disorder, if any

How is Drug-Induced Raynaud Phenomenon Treated?

The following measures may be considered in treating Drug-Induced Raynaud Phenomenon:

• Discontinuing the medication responsible for the side effect may result in a cure, or in improvement of the condition
• Avoidance of cold conditions and cold weather; wearing protective (warm) clothing
• Avoiding the triggers causing the condition
• Psychological counseling for stress; cognitive behavioral therapy including the use of antidepressants and anti-anxiety medications, if necessary
• Medication to block the abnormal narrowing of the blood vessels
• In rare cases, if the symptoms are severe, a surgical procedure called sympathectomy can be performed. It is important to note that this surgery is not performed in a vast majority of individuals
• In some severe cases, medications to decrease vasoconstriction may be administered
• Symptomatic and supportive therapy, as necessary

Note: If any of the prescribed treatment medication or methods cause new stinging or burning symptoms, then it is important to discontinue the medication/method and immediately inform the healthcare provider.

How can Drug-Induced Raynaud Phenomenon be Prevented?

Current medical research has not established a method of preventing Drug-Induced Raynaud Phenomenon. However, the following measures may be considered to help lower one’s risk for the condition:

• Drugs that cause Raynaud phenomenon may be discontinued or alternative medication prescribed
• Inform your physician if you are allergic to any medication
• Avoiding exposure to cold weather and cold temperatures; use protective and warm clothing
• Managing stress, modifying certain lifestyle factors such as avoiding smoking

What is the Prognosis of Drug-Induced Raynaud Phenomenon? (Outcomes/Resolutions)

• The prognosis for Drug-Induced Raynaud Phenomenon is usually good in many cases, upon discontinuation of the medication and adequate treatment of the skin condition, when needed
• However, the prognosis may also depend upon the severity of the condition. In some individuals, Raynaud phenomenon is known to be severe

Additional and Relevant Useful Information Drug-Induced Raynaud Phenomenon:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/health-topics/vein-and-vascular-center/