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Raynaud's Phenomenon

Raynaud’s phenomenon is a complex vascular disorder in which blood vessels, particularly those in the fingers and toes, or rarely the tongue, nose, ears, lips, or nipples, overreact to cold temperature or emotional stress (Mayo Clinic 2011c; Herrick 2012; Martínez 2011). The blood vessels constrict (ie, vasoconstriction),reducing blood flow to the affected extremity. This results in numbness while blood flow is reduced and tingling and/or pain as blood flow returns to the affected area (Herrick 2012; Martínez 2011). These attacks may last from minutes to hours, and the intensity of discomfort may vary from mild to severe (Malenfant 2011; NCBI 2011; Martínez 2011).

The hallmark of Raynaud's phenomenon is the transitioning of the affected extremities from white to blue to red over the course of an “attack”, representing lack of oxygen, cyanosis (a consequence of lack of oxygen), and restoration of blood flow, respectively. This classic “tricolor phenomenon” represents a key diagnostic criterion in the clinical management of Raynaud’s (Herrick 2012; Martínez 2011).

There are two types of Raynaud’s phenomenon: primary and secondary.

  • Primary Raynaud’s phenomenon (Raynaud disease) in which no underlying cause can be identified, is the result of a spasm (constriction) of the blood vessels; it generally does not lead to permanent tissue injury. Some medications or occupational exposures can cause the condition as well (Malenfant 2011). Most people with Raynaud’s phenomenon have the primary form (Herrick 2012).
  • Secondary Raynaud’s phenomenon is related to an underlying cause (Martínez 2011). Autoimmune diseases such as lupus or, especially, scleroderma are often associated with secondary Raynaud’s phenomenon (Malenfant 2011; Herrick 2012). The secondary form is usually more serious and may severely compromise the affected tissue, potentially leading to ulceration, gangrene, and loss of affected digit(s)(Mayo Clinic 2011c; Herrick 2012; Pauling 2012; Stewart 2012).

The primary form of Raynaud’s phenomenon is often controllable with lifestyle changes, such as avoiding cold temperatures and wearing gloves, but the secondary form generally requires medical treatment to address the underlying cause (Malenfant 2011; Herrick 2012).

In many cases, individuals who experience Raynaud’s phenomenon do not discuss their symptoms with their doctor, considering them just a periodic nuisance (Stewart 2012). This is unfortunate, because some people initially thought to have primary Raynaud’s phenomenon (Raynaud disease) go on to develop a systemic autoimmune disease, and early recognition can help improve management and outcomes (Herrick 2012). Those who experience episodes of Raynaud’s phenomenon should mention their symptoms to their physician, since simple blood tests and clinical examinations can help rule out a potentially serious underlying disease (Herrick 2012).

Unfortunately, many available medications provide only partial relief. However, topical nitroglycerin, which was originally investigated decades ago for Raynaud’s phenomenon, has received renewed interest after some recent trials demonstrated efficacy. The re-emergence of topical nitroglycerin therapy holds promise for patients with both primary and secondary Raynaud’s phenomenon, and has low potential for systemic side effects, since it is administered topically only to the affected body parts (Hummers 2012; Mediquest 2012; Chung 2009; Herrick 2012).

In this protocol you will learn about the primary and secondary forms of Raynaud’s phenomenon, and what causes them. Conventional treatment strategies will be outlined, and several promising emerging therapies will be discussed. In addition, the potential therapeutic role of several natural interventions will be examined.