If your fingers and toes dread winter, help is at hand…
Raynaud’s phenomenon is a disorder of tiny skin arteries (arterioles) that go into spasm, constricting to reduce the skin’s blood supply especially in extremities such as fingers, toes, noses and ears. You’ll notice the affected area suddenly goes pale and cold, then turns dusky blue, feeling numb or painful as the tissues start to run short of oxygen. Eventually, the spasm relaxes, blood starts to flow and your skin turns red and feels warm again with no lasting effects. In severe cases, prolonged vasoconstriction (arterial narrowing) can lead to ‘frostbite’ with ulcers or even gangrene.
What causes it?
Raynaud’s affects around 10 million people in the UK – up to one in five women, but fewer men. In nine out of 10 people with the condition, there’s no obvious cause, and this is called Raynaud’s disease. It usually starts in early adult life and can run in families. Raynaud’s is often triggered by cold or stress, but has also been linked to oestrogen and smoking. But 10% of people with Raynaud’s phenomenon do have an underlying cause. This is called Raynaud’s syndrome. It’s linked to many conditions, including inflammatory and immune-system disorders such as rheumatoid arthritis, lupus or scleroderma (which produces smooth, thickened bent fingers), diabetes or an underactive thyroid, arterial diseases, infections, toxins, cancers or blood disorders. Many drugs trigger Raynaud’s syndrome, too, especially beta blockers (whose names end in -olol), caffeine, some migraine treatments, the contraceptive
pill and chemotherapy. The associated Raynaud’s condition, Vibration White Finger, tends to affect more men, as it’s caused by the vibrations from power tools.
Raynaud’s phenomenon is easily diagnosed as you can see it happening. Blood flow can be monitored using digital plethysmography and thermal imaging, which tracks vasoconstriction as ‘cold spots’ until blood flow returns.
If your Raynaud’s began as a youngster and you’re otherwise well, you probably have Raynaud’s disease and may not be offered tests. If your GP suspects Raynaud’s syndrome, you may need blood tests, X-rays or scans to check for causes, or tests to check your circulation.
If self-help (see tips box, left) doesn’t work, your doctor can prescribe drugs to open up your arterioles, such as rub-in gel, glyceryl trinitrate.
Oral calcium-channel blocker drugs, such as nifedipine, relax arterioles. Taking them reduces the severity and number of attacks, but they can dilate blood vessels and cause flushing, headache and ankle swelling, so you may prefer to take them only when needed – eg, when going out in the cold.
If you get very severe attacks, you may be offered intravenous injections of the drug iloprost, which widens the blood vessels. Surgery to improve the circulation may be used when nothing else has worked.
6 Ways to help your circulation
- Try cutting out caffeine and any medicines that may be making it worse. Don’t smoke.
- Take regular exercise as it may improve circulation.
- Wrap up – wear gloves, socks, a scarf and a hat.
- Don’t touch cold objects, such as drinks or cold surfaces, and wear gloves to reach into the freezer.
- If you get an attack, place your hands and feet in warm water (not hot as this can cause chilblains).
- Contact the Raynaud’s & Scleroderma Association (0800 917 2494; raynauds.org.uk) for advice, portable heat packs and heated clothing, such as gloves.