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Raynaud's Disease
Raynaud's Disease is a vasospastic disorder
most commonly affecting the hands and feet. A vasospasm occurs when the
smooth muscles controlling the small arteries supplying circulation
into the hands and feet contract. This smooth muscle contraction, or
spasm, makes the arteries so small that blood has difficulty passing
through. The most common event causing the vasospasm is exposure to
cold temperature. Raynaud's disease must be differentiated from
Raynaud's phenomenon. Raynaud's disease is a disease that is not
associated with any other specific disease entity. Raynaud's phenomenon
has the same findings, as Raynaud's disease except there is an
underlying disease associated with the vasospasm. Raynaud's phenomenon
may be seen with rheumatoid arthritis, scleroderma, lupus, and other
diseases. The condition is aggravated by smoking. A single cigarette
may decrease the circulation by one half for more than an hour.
Raynaud's disease is most common in young women, and has no known
cause. It typically is found in both feet and both hands. It appears
that the threshold for vasospasm is lowered in these individuals, and
may occur following exposure to cold, or during times of stress. Diagnosis The
diagnosis of Raynaud's disease is a clinical diagnosis based upon the
patients' symptoms and the findings on examination. Patients with
Raynaud's disease will often hear the expression, ""Cold hands, warm
heart"" when shaking hands with others. This is because the arterial
vasospasm decreases blood flow into the hands and feet. In addition to
the cold skin temperature, there is a pattern of color changes seen in
the fingers and toes. Initially after exposure to cold, the toes and
fingers will turn white, then as the oxygen is depleted they become
cyanotic which is a blue color, finally the spasm relaxes and there is
an excess of blood flow which turns the toes red and warm (reactive
hyperemia). This pattern of triphasic color change, white to blue to
red, is a hallmark of Raynaud's disease. However, not all individuals
will have the triphasic (three-color) change. Some will have a biphasic
(two color) change going directly from white to red. The
length of vasospasm may last from several minutes to several hours.
This may be accompanied by pain, or more commonly by numbness. In
severe cases there may damage to the skin on the tips of the toes and
fingers with an appearance similar to frostbite. These areas may
develop into ulcers (sores) which can be very painful. Treatment In
mild forms of Raynaud's disease the simplest treatment is to protect
the hands, and feet from cold exposure. Since cold is the cause of the
vasospasm, preventing exposure to cold will prevent the spasm from
occurring. This may require insulated boots and thick warm socks in
colder climates. Dressing in layers, with new polyester liners and new
insulating materials may be helpful. Most sporting goods stores that
stock hiking or camping equipment will be able to help in this regard.
Cigarette smoking contains nicotine, which is known to cause vasospasm.
Discontinuation of cigarette smoking will be a definite benefit for the
individual with Raynaud's disease. In more severe cases, or in those
with recurrent episodes, medications are available to help relax the
arterial smooth muscle. Medications that have been used successfully in
some individuals include phenoxybenzamine, prazosin, nifidipine, pentoxyphylline, and guanethidine. These medications are only available by prescription, and patients must be monitored for potential side effects.
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