Raynaud's Syndrome

Strategies to Reduce Attacks of RS

A first line of defense against RS, whether primary or secondary, is to protect the extremities from common triggers of attacks such as cold or emotional and physical stress.

Protect Your Body. Extreme changes in temperature are worse than cold alone. If you have RS:

• Keep your head and torso warm to enable blood to flow more freely to your hands and feet (AF 2004).
• Wear socks to bed.
• Use an electric blanket to warm the sheets before getting into bed.
• Dress in loose layers of blended fabrics, including a sweater.
• Wear long underwear made of silk to protect against chills without overheating the body.
• Wear a warm hat and earmuffs to prevent heat loss through the head when outside.
• Use chemical-pack heaters inside socks and mittens.
• Warm body parts by using tubes of fabric filled with grain that can be warmed in a microwave and then applied to affected areas.
• Cover exposed skin (including nose and cheeks) in cold, windy weather.
• Avoid getting the skin wet or perspiring in cold weather. Moisture cools the skin as it evaporates.
• Wear an under layer of clothing in a material that wicks away moisture.
• Be prepared for temperature changes by having extra clothing available in your car or at work.
• Drink warm beverages.
• Carry an insulated hot water bottle with you on car trips.

Protect Your Hands. Damp cold is more likely to precipitate an attack. Take the following steps to protect your hands from cold temperatures:

• Wear mittens and wristlets outside in cold weather. Mittens warm hands more effectively than gloves because they pool heat from the entire hand. Wristlets keep cold air out of the gap between sleeves and mittens.
• Wear mittens to bed.
• Wear mittens when handling cold or frozen foods (NIAMS 2001).
• Never clean vegetables under cool, running water; use warm water. Or use already-prepared vegetables from the produce department.
• Run bath or shower water ahead of time to avoid touching cold water.
• Avoid touching the cold water from garden hoses.
• Do not hang wet clothes outside.
• Do not shovel snow.
• Do not hold cold beverages. Use insulated cup holders and straws.

Protect Your Skin. People who have RS should take precautions with skin care because minor cuts and scrapes take longer to heal and are more susceptible to infection:

• Take care not to injure skin, particularly areas affected by RS.
• Wear gloves when using detergents or harsh chemicals.
• Wear gloves when gardening.
• Treat injuries without delay.
• Consult a healthcare provider if infection or skin ulcers develop.
• Use creams to keep skin soft. Rough, dry skin is more likely to tear (Cleveland Clinic 2005).

Rewarm Affected Areas. A prolonged attack of RS can lead to tissue death, gangrene, and possibly amputation. Consider each attack an emergency and respond immediately. Try to remain calm when an attack begins (AF 2004). Gently rewarm fingers and toes as soon as possible. The sooner rewarming is started, the easier it will be to restore circulation and lessen the chance of damage. Try moving the affected part right away, which may avert the need for further measures. If moving the affected body part does not result in the alleviation of symptoms of RS, try applying moist heat. Become familiar with the following rewarming strategies (AF 2004):

• Do not clap your hands together or rub them vigorously. Doing so can damage blood vessels.
• Place your hands under your armpits or between your legs.
• Cup your hands to your mouth and breathe on your fingers.
• Have another person hold (but not rub) your hands.
• Wiggle your fingers and toes.
• Walk (or otherwise move) around.
• Twirl your arms around in the air in large circles until circulation returns. Avoid twirling your arms, however, if scleroderma has damaged your blood vessels.
• Run warm (but not hot) water over the affected body parts until normal color returns.
• Do not overheat hands to avoid constricting blood vessels and prolonging an attack.

Avoid Vasoconstrictive Substances. Try not to consume food or medications, or be around substances, that can constrict blood vessels:

• Do not smoke. Smoking constricts peripheral blood vessels (AS 2005) and reduces the blood concentration of antioxidants such as ascorbic acid (Herrick AL et al 1994; Yale 2004).
• Avoid breathing second-hand smoke.
• Cut down on your intake of caffeine-containing foods, beverages, and drugs. Caffeine, a vasoconstrictor, can be found in chocolate and some aspirin preparations, teas, and medications (ISN 2005).
• Do not use birth-control pills (Yale 2004).
• Avoid taking most over-the-counter decongestants, cold remedies, and diet pills (NIAMS 2001).
• Have your doctor monitor your condition closely if you take medications for migraines, high blood pressure, or heart problems. Some migraine headache, blood pressure, and heart medications can cause symptoms of RS (NIAMS 2001).

Avoid Precipitating Activities. Attacks of RS may be initiated by operating vibrating equipment such as chain saws, jackhammers, or drills (NIAMS 2001). When using a vacuum cleaner, try wearing oven mitts to reduce the effect of the vibrations. Symptoms of RS can also be brought on by repetitive hand motions (such as those used while typing, playing the piano or guitar, sewing, and chopping or dicing food). Do not carry heavy shopping bags with handles that restrict blood flow to fingers.

Use Biofeedback. Blood vessels can be trained to relax using biofeedback (NIAMS 2001). In one form of biofeedback, you “think” that your hands are warm. In another form of biofeedback, you place your hands in a bowl of warm water (in a warm room) for 5 minutes, then move to a cold room or cold environment. Then you again place your hands in warm water, this time for 10 minutes. Repeat the procedure several times a day for as many days as necessary to produce a conditioned reflex that is the opposite of the normal one: that is, when exposed to cold, the blood vessels in the fingers will dilate rather than constrict (without the aid of warm water). The success of biofeedback has been documented by studies. Biofeedback subjects showed significant elevations in blood flow to, and temperature of, the fingers and in skin conductance level beyond what could be explained by other differences in the study groups (Freedman RR 1989). Improvement in symptoms was maintained 9 weeks, 1 year, and 2 years in RS and 8 years in RS secondary to systemic lupus erythematosus (Freedman RR et al 1988; Keefe FJ et al 1980; Sappington JT et al 1985). Biofeedback is generally not as effective in treating secondary RS as it is in treating primary RS. It may also not work as well for warming the feet.