Raynaud disease refers to reversible ischemia of peripheral arterioles, usually in response to cold exposure or emotional stress. It is more prevalent in women and most often affects the fingers, although the toes, face, ears, nose, and nipples may be involved. Secondary Raynaud phenomenon occurs in association with a related disease process, such as systemic lupus erythematosus or scleroderma.
A typical episode usually starts suddenly with the onset of cold digits associated with sharply demarcated, blue or white, color changes. With rewarming, erythema develops due to a reactive hyperemia. The vasospasm may last for several hours but usually resolves with removal of the initial stimulus.
Management and Disposition
Treatment involves removal of the inciting stimulus. As many cases are induced by going from a warm to a cold environment, active rewarming with warm water soaks or placing in the axilla is generally effective. Sympathetic stimulation may also trigger an episode, so calming patients who are anxious or removing them from stressful situations may be efficacious.
A thorough history and examination should be performed with careful attention paid to signs and symptoms of connective tissue disorders. Acrocyanosis (Crocq disease) is a circulatory disorder in which the hands and, less commonly, the feet are persistently cold and blue; some forms are related to Raynaud phenomenon. Counseling patients about methods for reducing the frequency and duration of attacks is helpful, including avoiding sudden cold exposure, minimizing stress, keeping the digits warm, avoiding cigarette smoking, and avoiding sympathomimetic drugs.
Raynaud Disease. A patient with sharply demarcated color changes consistent with an acute attack of Raynaud phenomenon due to cold exposure. (Photo contributor: Kevin J. Knoop, MD, MS.)
A history of cool skin and sharply demarcated color changes is essential for diagnosis.
Routine ordering of blood tests, such as erythrocyte sedimentation rate (ESR) or antinuclear antibody (ANA), is not recommended unless other symptoms of connective tissue disorders are present. In these cases, close primary care or rheumatology follow-up is recommended.
Raynaud Disease. A patient with sharply demarcated color changes characteristic of an acute attack of Raynaud phenomenon. (Photo contributor: Katherine Farmer, MD.)
Acrocyanosis. Persistently blue and cold fingers. (Photo contributor: Lawrence B. Stack, MD.)