What is Raynaud's?

Raynaud's (pronounced ray-nose) is an exaggerated response to cold in the hands and the feet. It happens when the small blood vessels in those areas close down, allowing only a small amount of blood to get through. This extreme reaction may affect 10% of the population and is more common in women.

What are the symptoms?

When the affected fingers and toes are exposed to cold or sudden temperature change, they go a very distinctive white or blue colour and become numb. When they are warmed again, they go bright red and the numbness wears off to be replaced by painful throbbing.

The colour change is due to spasm in the small blood vessels in the skin of the hands and feet. These spasms may also occur in other areas such as the tip of the tongue and nose, earlobes and occasionally internal organs.

How is temperature normally regulated?

Our body temperature is controlled by the amount of heat retained or lost through the skin. This is regulated by the amount of the blood flowing through the small blood vessels of the skin. When we are hot, the blood vessels open wider, allowing more blood to flow through the skin. Heat is lost through the skin and we may look flushed.

When we are cold, these same blood vessels allow less blood to flow through them, so less heat reaches the skin surface. This system works very well and is controlled by special nerves and the mechanism is automatically controlled by the brain.

What causes Raynaud's?

The cause is unknown and there is no cure, but practical measures can be taken to prevent attacks. The use of chainsaws, jackhammers or similar vibrating equipment may bring on a Raynaud's attack.

In a small number of people, Raynaud's may be the first indication that an underlying condition, such as a connective tissue disease called scleroderma, may be present. A simple blood test can be done that looks for special markers or antibodies in your blood that show whether or not you have this condition. If the test is positive, your doctor will carry out further tests.

Is Raynaud's a serious condition?

Most attacks are not serious and are no cause for alarm. Once the blood supply is restored, usually by warming, the fingers may be bright red for a while, and throb, but will then return to normal. In those with more serious reactions or underlying disease, small ulcers may develop at the tips of the fingers, or chilblains or cracked skin may appear around the nails.

How is Raynaud's treated?

Medication may be needed if the Raynaud's symptoms interfere greatly with quality of life. There are also many practical precautions that can be taken:

• try to keep your body temperature constant by wearing several layers of clothes. Mittens are warmer than gloves because the fingers keep each other warm. Tight gloves can cut off blood circulation in the fingers - exercise is excellent for keeping warm, but is not effective if you are experiencing an attack
• learn how to handle stress because it can trigger an attack
• use skin cream to keep your skin supple and soft
• always wear a hat: you lose a lot of heat through the top of your head - don't smoke: smoking causes constriction of blood vessels
• keep the affected skin dry: as water on the skin evaporates, it cools the skin which makes the circulatory changes worse
• keep the affected areas covered: wear gloves, socks, and if it is very cold and windy, putting a scarf across your nose and cheeks will protect them and help you breathe better. If you are so cold that it hurts, go inside. Pain is a warning signal
• try to avoid sharp changes in temperature: a change in temperature is more likely to bring on an attack than just being in the cold. Do not sit in draughts.
• keep your fingernails and hands clean at all times. Be particularly careful of your hands and protect with suitable gloves when gardening or doing jobs around the house
• do not get things from the freezer without using insulated gloves or mittens
• do not handle cold items such as milk bottles straight from the fridge as this can bring on a spasm in the fingers - if you are going on a trip and it's likely to be cold, take a hot water bottle or 'Heat Wheat' mitts which can be warmed in the microwave
• do not carry heavy shopping bags with handles because this can restrict the blood flow to the fingers: use shoulder bags where possible
• keep the rooms you use most often at a comfortable temperature
• start running your bath or shower water ahead of time so that you do not touch cold water. Be careful not to get chilled getting in and out of the tub or shower
• have someone start your car and turn on the heater a few minutes before you leave the house
• try to avoid sweating too much or make sure you use clothes that wick sweat away from the body, because sweat cools the body
• do not peel vegetables under a running tap, hose the garden if the hose nozzle leaks or hang wet clothes on a clothes line
• when you have an attack, try to stay calm. Gently re-warm your fingers or toes as soon as you can. Placing your hands under your armpits often helps. Try wiggling your fingers or toes; move or walk around to try and improve your circulation. If you can, run warm, not hot, water over the affected part of your body until normal colour returns.

Original material supplied by Arthritis New Zealand. Reviewed by everybody, July 2005.