Introduction:

Raynaud's phenomenon, also called Raynaud's syndrome or disease, is a condition where blood vessels in the fingers and toes (and sometimes in the earlobes, nose, and lips) constrict and cause the skin to turn a pale or a patchy red to blue. It is usually triggered by cold or emotional stress. Episodes are intermittent and may last minutes or hours. The condition affects about 5 - 10% of the U.S. population, and it affects women five times more often than men. It usually occurs between the ages of 20 - 40 in women and later in life in men. It can exist alone (primary Raynaud's) or in conjunction with other conditions (such as scleroderma, lupus, and rheumatoid arthritis).

Signs and Symptoms:

• Changes in skin color in the fingers or toes and sometimes in the nose, legs, or earlobes (may occur in three phases: white, blue, then red)
• Throbbing, tingling, numbness, and pain
• Deterioration of the pads on fingertips or toes
• Gangrenous ulcers near fingertips

What Causes It?:

No one knows what causes primary Raynaud's phenomenon. Risk factors include the following:

• Cigarette smoking
• Age in women (onset primarily between the ages of 20 - 40)
• Occupation (for example, using vibrating tools such as chain saws and jackhammers)
• Drug use, including some cancer drugs, narcotics, and over-the-counter cold medications
• Previous frostbite
• Repetitive physical stress (for example, typing or playing the piano)
• Psychological stress
• Other medical conditions, such as rheumatoid arthritis, scleroderma, systemic lupus erythematosus, and carpal tunnel syndrome. When Raynaud's accompanies these conditions, it is called secondary Raynaud's and is generally more severe.

What to Expect at Your Provider's Office:

Your health care provider may conduct several blood tests, such as the antinuclear antibody test and the erythrocyte sedimentation rate (ESR), to look for connective tissue disease or other autoimmune disorders. If you have primary Raynaud's phenomenon, your health care provider will most likely begin with a conservative approach involving nondrug and self-help measures (for example, dressing warmly, avoiding the cold, controlling stress).

Treatment Options:

One of the most important preventive measures you can take is to stop smoking because nicotine shrinks arteries and decreases blood flow. Other preventive measures include the following:

• Protecting yourself from cold, especially outdoors in the winter
• Guarding against cuts and other injuries to affected areas
• Avoiding caffeine
• Avoiding stress
• Exercising to increase circulation

These actions are often enough to manage Raynaud's phenomenon.

Drug Therapies

Several types of drugs are used to treat Raynaud's phenomenon. Calcium-channel blockers can reduce the frequency and severity of attacks, but the effects are small, about three to five fewer attacks per week. Your doctor may also recommend vasodilators (drugs that open up blood vessels). A powerful antioxidant agent, N-acetylcysteine, has been shown to decrease the frequency and severity of Raynaud's phenomenon. Researchers believe that N-acetylcysteine seems to act as an effective vasodilator in the treatment of Raynaud's phenomenon.

Surgical Procedures

In severe cases, a surgical procedure called sympathectomy, which severs the nerves that control constriction of the blood vessels, may be used.

Complementary and Alternative Therapies

Nutrition

• Vitamin E (400 - 800 IU per day) improves circulation and helps certain blood cells function well.
• Inositol hexaniacinate, a form of vitamin B3 or niacin (500 mg three times per day), may reduce frequency of Raynaud's attacks.
• Magnesium (200 mg three times per day) dilates blood vessels. Take with meals and reduce dose if diarrhea occurs.
• Omega-3 oils, found in fish oils (1,500 mg two to three times per day), may reduce symptoms in those with primary Raynaud's.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

The following herbs are circulatory stimulants with other properties as well. Take 20 - 30 drops two times per day.

• Hawthorn berries (Crataegus laevigata or oxycantha) (250 mg per day) strengthen and mildly dilate blood vessels. Do not take hawthorn if you have heart failure or are being treated for heart disease.
• Ginkgo (Ginkgo biloba) (360 mg per day in three doses) can dilate blood vessels and increase circulation in the fingers. Talk to your health care provider before taking ginkgo, especially at such a high dose. Ginkgo can interact with several herbs and medications, particularly blood thinning medications.
• GLA, found in evening primrose oil or borage oil (1 - 2 capsules), applied topically to the fingertips, may improve circulation.
• Ginger (Zingiber officinale) (225 mg two times per day) and prickly ash bark (Xanthoxylum clava-herculis) enhance circulation. Do not take ginger if you take blood-thinning medication.

Homeopathy

Homeopathy may be useful as a supportive therapy.

Hydrotherapy

Hydrotherapy consists of the expert application of water at differing temperatures to various body parts to increase circulation and oxygenation. Because of the potential for complications in Raynaud's phenomenon, hydrotherapy treatments should be done only under the supervision of a licensed naturopathic physician and in conjunction with your regular doctor.

Acupuncture

Although no major studies have looked at the effectiveness of acupuncture in treating Raynaud's syndrome, acupuncture may increase blood flow and decrease pain in some patients.

Following Up:

Most milder cases can be controlled through self-help measures.

Special Considerations:

Many drugs used to treat Raynaud's phenomenon can affect a growing fetus and should not be used by pregnant women. Mild-to-severe depressive symptoms are common so patients should be carefully monitored. Migraine is also significantly increased in patients with Raynaud's phenomenon.