Many people delight in the invigorating, brisk air of fall and winter. Children dance about and utter sounds of glee as they puff their cheeks like a blowfish and reveal the magic of seeing their breath in the air. But for those of us with Raynaud’s, the changing of seasons brings something quite different.
Since the discovery of this rare disorder by French doctor Auguste Gabriel Maurice in the 19th century, our understanding of Raynaud’s isn’t that different, but we have learned a few things.
Raynaud’s by Different Names
Raynaud’s can be (primary) or occur with certain other disorders (secondary).
When Raynaud’s occurs by itself, it is called:
- Raynaud’s disease or
- Primary Raynaud’s phenomenon
Raynaud’s disease is more common, and the onset is usually before the age of 30. If properly managed, it is not overly troublesome.
Secondary Raynaud’s on the other hand, pardon the pun, occurs with diseases, such as scleroderma, fibromyalgia, thoracic outlet syndrome, carpal tunnel syndrome, rheumatoid arthritis, systemic lupus erythematosus, polymyositis, dermatomyositis, Sjogren’s syndrome, mixed connective tissue disease, or other complex tissue and blood vessel disorders. It generally occurs after the age of 40.
*Your doctor may order a cold stimulation test, do a nail fold capillaroscopy, or vascular ultrasound to confirm diagnosis.
When Your Fingers, Nose, and Toes Turn Blue
Raynaud's affects the fingers, toes, and sometimes the nose or nipples. It occurs with exposure to cold and sometimes results from stress. And, while the order of color changes can be different between individuals, and the same color changes may not be present in all events, it is quite painful.
The initial phase is usually characterized by pallor, white as a fresh winter snow (indicating absence of blood flow). Next, the color transitions to the blue of a clear winter-crisp mountain sky. This acrocyanosis, as it is called, indicates change due to a decrease in blood flow (beginning to lose circulation before turning pale) or an increase in blood flow (from pale to blue).
During the re-warming phase, colors change like fall leaves gradually turning red before returning to normal skin color. In worrisome cases, Raynaud’s tissue can turn the color of dead wet winter leaves indicating irreversible tissue damage. This sign of necrosis (tissue death) can lead to gangrene, loss of tissue, and possible amputation.
Color changes are not the only thing that distinguishes this perplexing disorder. The person experiencing the attack cannot feel it, they are completely numb, yet the extreme cold can be felt by someone else. The lack of sensation is comparable to the local anesthetic used by a dentist. This is why it is important to use protective measures until feeling returns.
The Nerve of it All
The vibrant color changes of Raynaud’s are thought to be due to disruptions between nerves and small blood vessels (called capillaries). When these small vessels spasm skin is deprived of blood and oxygen. As blood flow gradually returns with re-warming, the red, blotchy, and very painful colors come alive, and stinging and burning sensations let us know nerves that have been asleep are reawakening like Rip Van Winkle after his long nap.
It is suspected these things occur due to a disruption in the sympathetic nervous system, but the cause of Raynaud’s is unknown. It can run in families, women are slightly more susceptible, and symptoms are more common in colder climates.
Preparedness – Finding a Middle Ground
- Re-warm slowly. Warming too quickly can cause blood vessels to shut down and delay recovery.
- Initially shake your extremities to improve circulation.
- Avoid vigorous rubbing to minimize damage to blood vessels.
- Use low heat, such as a moist heating pad or lukewarm water. Test on skin that is not affected.
- Protect fingers, toes and nose from cold exposure to prevent frostbite and skin ulcers.
- Avoid emotional stress.
- Avoid alcohol, particularly when you know you will be exposed to cold.
- Don’t smoke.
- Avoid use of tools that vibrate the hands.
- Report any unusual symptoms or skin breakdown to your physician immediately.
*Vasodilator medications may be indicated in severe cases.
- Medications that cause blood vessels to narrow have also been associated with Raynaud’s, so always consult with your physician or pharmacist.
Symptoms can occur with the slightest change of seasons. Even ambient temperatures in grocery or department stores can initiate an attack, so be prepared. I carry gloves with me year round, and in colder months, I carry extra socks. Cover exposed areas with a facemask, vest, or scarf and use disposable hand and foot warmers. We may need to alter our lifestyle somewhat to accommodate Raynaud’s, but when we understand the complications, we are more likely to use preventative strategies that keep us safe from permanent injury.