Dear Dr. B: What causes Raynaud’s disease and what can I use to lessen the symptoms? Yours, A Regular Reader (RR).

Dear RR: Maurice Raynaud (1834-1881), a physician and professor in Paris, first wrote his thesis on this subject in 1862.

Raynaud’s disease defines a condition characterized by episodic spasm of blood vessels (arteries and arterioles) in the hands and feet. The spasm of the blood vessels is triggered by exposure to cold or emotional stimuli. This results in closure of the small arteries. Fingers and hands are more frequently involved than toes and feet.

The classical syndrome consists of intense blanching of the fingertips, followed by cyanosis (bluish tinge of the skin due to lack of oxygen), followed by redness on the fingertips due to rewarming and return of oxygenated blood, with full recovery occurring in 15 to 45 minutes. This typical pattern occurs only in a small number of patients. Most patients have milder form of the disease. Blanching of the fingers is associated with pain.

Why do some people have sensitive blood vessels?

The mechanism of vessel spasm that occurs during an episode of Raynaud’s disease has interested many investigators for more than a century. But nobody has given a satisfactory answer. The role of nervous system remains unclear.

What percentage of people is affected by this condition?

This is hard to estimate in general population. But people who live in cool damp climates seem to have higher incidence (20-25 percent). People in certain occupations have higher incidence as well. About 40 to 90 percent of chainsaw operators and miners using vibrating equipment have Raynaud’s syndrome. Food workers who work in cold areas have about 50 percent incidence of this disease.

Women constitute 70 to 90 percent of most reported patients with Raynaud’s syndrome, says Sabiston’s Textbook of Surgery (15th Edition). Usually these are younger women typically under 30 years of age.

About 44 percent of patients with Raynaud’s have no underlying cause (idiopathic) i.e. not related to occupation or underlying diseases like autoimmune and atherosclerosis (hardening of the arteries). When it occurs as a complication of another disease, it is called Raynaud’s phenomenon.

The diagnosis of Raynaud’s disease is made by history, physical examination and specialized laboratory tests. Again, the tests not very specific.

RR asks: what can I do to lessen the symptoms?

Most patients with Raynaud’s syndrome have only mild symptoms, which respond well to simple conservative treatment, including wearing of warm clothes and gloves. Avoid cold environment. Do not smoke. About 10 percent of patients have sufficiently severe and frequent episodes to require drug therapy. Vasodilators are most frequently used. But none of the drugs have been properly evaluated.

Surgical treatment in the form of sympathectomy (division of autonomic nervous system) causes dramatic improvement in occasional patient but can be unpredictable and disappointing.

RR, 140 years have gone by since Maurice Raynaud described this condition. I am not sure whether I have answered your question satisfactorily. But in a nutshell, my highly intellectual and scientific advice is – avoid cold environment, do not smoke and keep your hands warm!

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