Raynaud’s Syndrome

Raynaud’s Syndrome

Raynaud’s syndrome is an attack of reduced blood flow in the acres (outer extremities) as a result of vasoconstriction (vascular spasms), which affects women four to five times more often than men. Depending on the form of the disease, Raynaud’s syndrome can be treated well and has a good course.

What is Raynaud’s Syndrome?

Raynaud’s syndrome is the term used to describe attacks of ischemia (reduced blood flow) caused by vasoconstrictions or vasospasms (vascular spasms), which primarily affect the arteries in the fingers and toes. For what is insect venom allergy, please visit beautyphoon.com.

The attacks are characterized by ischemia (pallor as a result of reduced blood flow), cyanosis (bluish skin changes) as they progress, and painful reactive hyperemia (excessive accumulation of blood) as a result of the irritation of vascular segments.

In the further course, Raynaud’s syndrome is also accompanied by damage to the vessel walls such as a thickening of the intima (innermost layer of the vessel wall) and/or a capillary aneurysm (vasodilation) with subsequent necrosis (cell death) and gangrene (self-dissolution of dead tissue).

In principle, two forms of Raynaud’s syndrome are differentiated. While primary Raynaud’s syndrome cannot be traced back to an underlying disease, secondary Raynaud’s syndrome is associated with certain diseases such as thromboangiitis (chronic inflammatory vascular disease), scleroderma (connective tissue disease) and trauma (e.g. working with a jackhammer) or intoxications (e.g. heavy metals, certain medications).

Causes

The causes of primary Raynaud’s syndrome have not yet been finally clarified. The disease is probably based on a genetic predisposition for vasospastic diseases, since in many cases it can be associated with other diseases caused by vascular spasms such as migraine or angina pectoris (Prinzmetal’s angina).

An involvement of hormonal factors is also discussed for the manifestation of primary Raynaud’s syndrome. Secondary Raynaud’s syndrome, on the other hand, is due to various diseases that cause Raynaud’s syndrome to manifest itself. About 40 underlying diseases (including thromboangiitis obliterans, collagen diseases, rheumatoid arthritis, arteriosclerosis, cryoglobulinemia, cold agglutinin syndrome) are known which can trigger secondary Raynaud’s syndrome.

In addition, certain medications (beta blockers, ergotamine), excessive drug and nicotine consumption, and poisoning with heavy metals or vinyl chloride can cause secondary Raynaud’s syndrome.

Symptoms, Ailments & Signs

Raynaud’s syndrome manifests itself in attacks of cold or (emotional) stress. During such an attack, discoloration of the skin is symptomatic, which occurs mainly in the hands and feet. In rare cases, the nose, ears, forehead and chin are also affected.

In very rare cases, the nipples can also be affected in pregnant women. The most common is a white discoloration or a blue discoloration (cyanosis) of the skin. In other cases, a two-phase discoloration can be observed, from a white discoloration to a blue discoloration.

The discoloration of the skin can also be observed as a tricolor phenomenon, in which there is first a white discoloration, then a blue discoloration and finally a red discoloration. The red discoloration is explained by increased blood flow to the skin (hyperemia), which is usually accompanied by a tingling or throbbing sensation.

The Raynaud seizure can last from a few minutes to an hour. Pain or tingling may occur during staining. The coloring can appear symmetrically (primary Raynaud’s syndrome), observed here especially in the index finger, middle finger, ring finger and little finger, or asymmetrically (secondary Raynaud’s syndrome). In a few cases, the circulatory disorders can lead to secondary damage, such as necrosis of the skin, i.e. the death of individual cells.

Diagnosis & History

Raynaud ‘s syndrome can usually be diagnosed based on the characteristic symptoms such as pain and discoloration due to reduced blood flow. A symmetrical pattern of involvement of the second to fifth fingers indicates primary Raynaud’s syndrome.

If an attack is provoked by application of cold (ice water), relief can be achieved by application of heat or vasodilating nitroglycerin. If, on the other hand, there is an asymmetrical pattern of involvement of individual fingers and if heat and/or nitroglycerin cannot reduce the symptoms, secondary Raynaud’s syndrome can be assumed.

In addition, the blood flow in the affected fingers or toes can be checked as part of an oscillography, while a Doppler sonography allows statements to be made about occlusions or constrictions in the vessels. The course and prognosis are very good in primary Raynaud’s syndrome. In secondary Raynaud’s syndrome, the course depends largely on the underlying disease.

Complications

If the course is severe, the end phalanges of the toes and fingers are no longer sufficiently supplied with oxygen. As a result, the tissue can become diseased or even die. As a result, the fingertips or even entire fingers have to be amputated.

If the cramps persist for a longer period of time, this also leads to vascular damage in the long run. If the disease occurs as a result of scleroderma, there is also a risk of permanent changes in the blood vessels. Here, too, the affected tissue has to be amputated. If the symptoms are severe, drug therapy is required, which is always associated with complications. If glycerol trinitrate is prescribed, so-called “nitrate headaches” can occur.

When first used, there is also a risk of a drop in blood pressure, an increase in heart rate, dizziness and feelings of weakness. Occasionally, allergic skin reactions occur or the patient collapses. A serious complication is peeling disease. This severe skin reaction occurs in isolated cases and often leads to loss of hair and nails. If an infusion – for example with prostaglandins – is necessary, this can be associated with infections, injuries and occasionally with the development of thrombosis.

When should you go to the doctor?

Since Raynaud’s syndrome is an incurable disease, a doctor must always be consulted with this disease. There is no self-healing, whereby the complaints can only be treated purely symptomatically and not causally. The earlier the treatment of the disease is initiated, the higher the probability of a positive course of the disease.

A doctor should be consulted if the person affected suffers from discoloration of the skin due to Raynaud’s syndrome. These occur above all in severe stressful situations, although they can also be triggered by heat or cold. The skin can also turn blue. If these symptoms occur over a longer period of time, a doctor must be consulted. As a rule, circulatory disorders also indicate Raynaud’s syndrome and should always be examined by a doctor. Raynaud’s syndrome can be examined and treated by a general practitioner or by a dermatologist.

Treatment & Therapy

The therapeutic measures for Raynaud’s syndrome can only aim at reducing the existing symptoms, since the disease itself cannot be cured. Physical measures, systemic and topical (local) medication, as well as acupuncture and alternative healing methods are used in Raynaud’s syndrome.

In addition to education on prophylactic measures such as early wearing of gloves or use of pocket warmers to avoid exposure to cold, which would worsen the symptoms of primary Raynaud’s syndrome, training of the finger muscles is recommended. In addition, when taking medication that can cause Raynaud’s syndrome (beta blockers, certain antidepressants, hormones, ergotamines), a change in medication should be considered.

As part of drug therapy for Raynaud’s syndrome, ACE inhibitors and Ca antagonists (calcium antagonists such as felodipine, nifedipine, amlodipine) are administered, particularly in the case of frequent severe seizures.

In addition, nitroglycerin can be applied topically to relieve symptoms during severe attacks. In the advanced stage of secondary Raynaud’s syndrome, prostaglandins (iloprost, alprostadil) can be infused intravenously to prevent or treat necrosis.

A study was also able to show that classic Chinese acupuncture procedures can lead to significant improvements in terms of the severity and frequency of seizures in primary Raynaud’s syndrome.

Prevention

Since the causes of primary Raynaud’s syndrome are not known, there are no direct preventive measures. However, certain factors that can trigger onset or new seizures should be avoided. These factors include, for example, avoiding exposure to cold, abstaining from nicotine and reducing work with highly vibrating equipment (e.g. jackhammer). Early and consistent therapy of the underlying disease can possibly prevent secondary Raynaud’s syndrome.

Aftercare

Regular check-ups once a year at the treating doctor or in a specialist outpatient clinic are mandatory. Wounds should be treated promptly by a competent person to allow them to heal properly. Conscientious aftercare is essential, especially in the case of newly occurring wound healing disorders. Patients suffering from Raynaud’s syndrome or who have struggled with it in the past should diligently follow all recommended precautions.

Ideally, this will prevent the symptoms from recurring. Follow-up care also includes continuing to eat as healthily as possible. It is important to be economical with caffeinated stimulants. A vitamin-rich diet, on the other hand, can protect the blood vessels. At the same time, it is important to refrain from smoking and to avoid smoky rooms. The same goes for stress. Exercise is beneficial to recovery because it stimulates blood flow.

It is advisable to take pain and cold medication only after consulting a doctor who is aware of the patient’s medical history, as these medications may contain substances that constrict the blood vessels. Those affected should always wear warm gloves when it is cold and better not touch cold objects without protection.

If, despite all precautionary and aftercare measures, a Raynaud attack occurs again: as an immediate measure, hold your hands under warm water or in your armpits, massage and move them. In this way, the vessels dilate again quickly.

You can do that yourself

In the case of Raynaud’s syndrome, the first thing to do is to avoid the triggers. Hands and fingers must be specially protected from cold and wet. In winter it is important to always wear good insulating gloves, eg with a neoprene layer. Maybe only heated gloves or pocket warmers will help. Pressure on the palm increases the symptoms. This occurs, for example, when riding a bicycle or working with your hands in the cold. If such triggers cannot be avoided, preventive measures such as finger gymnastics, arm and hand movements and regular pressure relief can help.

Vasoconstrictive substances should be avoided. This includes nicotine in particular, but also some medications. It is therefore extremely important to inform the doctor about the disease, even if the current symptoms appear to have nothing to do with Raynaud’s syndrome.

Overall, a healthy lifestyle also improves vascular health. The reduction of stress and restlessness, as well as a balanced, vitamin-rich diet have a protective effect and can delay the progression of the disease. Sport with endurance training is particularly important, as it optimizes blood circulation throughout the body and has a calming effect on the nervous system.

None of the measures mentioned can cure the disease, but they can improve the quality of life and delay its progression.

Raynaud’s Syndrome