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

• Raynaud's Disease
• Raynaud’s Phenomenon
• Raynaud's Syndrome

What is 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 usually affects the extremities, especially the hands/fingers
• The mechanism of development of Raynaud Phenomenon is not well-understood. It is believed to be due to the abnormal and periodic narrowing of the small blood vessels in the hands and feet
• There are two main types of Raynaud Phenomenon:
  • Primary Raynaud Phenomenon: When the underlying cause of the condition is indeterminate, and all other possible causes of the signs and symptoms have been ruled out
  • Secondary Raynaud Phenomenon: It is called so when the underlying causes resulting in the characteristic signs and symptoms is determined. It may arise due to several factors/conditions such as certain blood disorders, medications, occupations, and trauma
• Raynaud Phenomenon can present with pale (whitish) areas on the fingers and hands, which then turn bluish, and subsequently red, due to blood flowing to the skin area. This can result in burning sensation, inflammation, and pain 
• Blood tests, imaging studies, and a tissue biopsy may be necessary to diagnose the underlying condition associated with secondary Raynaud Phenomenon. However, examination of the presenting symptoms may be sufficient to diagnose primary Raynaud Phenomenon
• In many individuals, treating the underlying condition adequately may help resolve Raynaud Phenomenon. The treatment measures may include the use of medication, stress therapy, and avoidance of cold conditions
• The primary form of Raynaud Phenomenon is generally mild and tends to resolve on its own, and the prognosis is excellent. The prognosis of secondary Raynaud Phenomenon is generally based on the associated condition and its severity

Who gets Raynaud Phenomenon? (Age and Sex Distribution)

• The primary form of Raynaud Phenomenon is more common in older children and young adults (15-30 years age range), although the secondary form is more common among older adults
• Individuals of any age group may be at risk
• Generally, females (especially young adult women) are affected more than males
• No racial or ethnic group predilection is observed and the condition is observed worldwide

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

• No risk factors have been presently identified for primary Raynaud Phenomenon. However, in some individuals, the condition can run in families

The risk factors for secondary Raynaud Phenomenon may include a variety of conditions such as:

• Living in cold temperatures; participating in outdoor activities during cold winters
• Infections such as Lyme disease
• Anorexia nervosa, eating disorder
• Connective tissue disorders such as Ehlers-Danlos syndrome, Sjögren's syndrome, systemic lupus erythematosus, rheumatoid arthritis, etc.
• Obstructive disorders including atherosclerosis, thoracic outlet syndrome, Takayasu’s arteritis, etc.
• Use of certain medications, such as beta-blockers, antibiotics, stimulants, chemotherapy agents, etc.
• Using any construction machine or tool that causes vibration, such as a jackhammers, pile drivers, excavators, and impactors
• Trauma to the hands or feet, such as due to accidents or frostbite
• A variety of cancers
• Certain blood disorders
• Emotional and psychological stress

The following factors may worsen the symptoms of Raynaud Phenomenon:

• Cold temperatures
• Smoking; caffeinated drinks
• Estrogen therapy

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 Raynaud Phenomenon? (Etiology)

Raynaud Phenomenon is a benign condition that occurs due to the narrowing of arteries, resulting in decreased blood flow to the fingers and toes. It is classified as primary and secondary based on the cause.

• If the cause of symptoms is unknown, then it is called primary Raynaud Phenomenon. Some researchers believe that the primary form may be due to certain genetic factors or may be inherited
• When factors leading to the causation of the condition are known, it is called secondary Raynaud Phenomenon. This may be from a variety of conditions including connective tissue disorders, certain occupations, stress, use of several medications, and certain lifestyle factors

It is observed that the symptoms get better during pregnancy; hence, some researchers believe that hormonal influence may play a role in the development of Raynaud Phenomenon.

What are the Signs and Symptoms of Raynaud Phenomenon?

The signs and symptoms of Raynaud Phenomenon may vary from one individual to another. It may also be mild or severe. 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, 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 in the nipples in a breastfeeding mother, resulting in a very painful condition
• Some individuals may have migraine headaches and chest pain
• Signs and symptoms from an underlying condition, if present

How is Raynaud Phenomenon Diagnosed?

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

• Complete physical examination with comprehensive evaluation of medical history
• 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 Raynaud Phenomenon?

The following complications may be noted from 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 present

How is Raynaud Phenomenon Treated?

The treatment measures depend upon whether the condition is primary or secondary. The following measures may be considered in treating Raynaud Phenomenon:

• 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 given
• Symptomatic and supportive therapy, as necessary
• For secondary Raynaud Phenomenon, undertaking treatment of the underlying condition/disorder

In many individuals, no treatment may be necessary for primary Raynaud Phenomenon, since the condition may be mild.

How can Raynaud Phenomenon be Prevented?

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

• Avoiding exposure to cold weather and cold temperatures; use of protective and warm clothing
• Considering the possibility of relocating to a warmer area
• Undertaking early diagnosis and treatment of any associated condition may be beneficial
• Inform your physician if you are allergic to any medication
• Managing stress, modifying certain lifestyle factors such as avoiding smoking
• Stopping or avoiding activities triggering the condition
• Changing work activities to avoid using vibratory equipment, when possible

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

• The prognosis of primary Raynaud Phenomenon is usually good, since it is usually mild in many individuals. Moreover, the condition is known to resolve by its own in some cases
• The prognosis of secondary Raynaud Phenomenon is based on the severity of the underlying condition it is associated with
• In general, the overall prognosis depends upon the severity of the signs and symptoms. In some individuals, Raynaud Phenomenon is known to be severe

Additional and Relevant Useful Information for Raynaud Phenomenon:

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

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