In medicine, Raynaud's disease or Raynaud's phenomenon (pronunciation: /reɪˈnoʊz/ ray-nohz) is excessively reduced blood flow in response to cold or emotional stress, causing discoloration of the fingers, toes, and occasionally other areas. This condition may also cause nails to become brittle with longitudinal ridges. Named after French physician Maurice Raynaud (1834–1881), the phenomenon is believed to be the result of vasospasms that decrease blood supply to the respective regions. When the disorder's cause is idiopathic, it is referred to as Raynaud's disease (also called primary Raynaud's); if the syndrome is secondary to another disease such as systemic sclerosis, Scleroderma, or other connective tissue disorders, it is correctly referred to as Raynaud's phenomenon (secondary Raynaud's). If Raynaud's phenomenon is suspected to be secondary to systemic sclerosis, one tool which may help aid in the prediction of systemic sclerosis is thermography. Its pathophysiology includes hyperactivation of the sympathetic nervous system causing extreme vasoconstriction of the peripheral blood vessels, leading to tissue hypoxia. Chronic, recurrent cases of Raynaud's phenomenon can result in atrophy of the skin, subcutaneous tissues, and muscle. In rare cases it can cause ulceration and ischemic gangrene.

Signs and symptoms The condition can cause pain within the affected extremities, discoloration (paleness), and sensations of cold and/or numbness. This can often be distressing to those who are not diagnosed, and sometimes it can be obstructive. If someone with Raynaud's is placed into a cold climate, it could potentially become dangerous. Example of Raynaud's phenomenon, viewed from the front of the hand Occurrence of Raynaud's phenomenon in only one finger in the hand. When exposed to cold temperatures, the blood supply to the fingers or toes, and in some cases the nose or earlobes, is markedly reduced; the skin turns pale or white (called pallor) and becomes cold and numb. When the oxygen supply is depleted, the skin color turns blue (called cyanosis). These events are episodic, and when the episode subsides or the area is warmed, the blood flow returns, and the skin color first turns red (rubor), and then back to normal, often accompanied by swelling, tingling, and a painful pins and needles sensation. All three color changes are observed in classic Raynaud's. However, not all patients see all of the aforementioned color changes in all episodes, especially in milder cases of the condition. Symptoms are thought to be due to reactive hyperemias of the areas deprived of blood flow. In pregnancy, this sign normally disappears owing to increased surface blood flow. Raynaud's has also occurred in breastfeeding mothers, causing nipples to turn white and become extremely painful. Nifedipine, a calcium channel blocker and vasodilator, was recommended to increase blood flow to the extremities and noticeably relieved pain in the breast in an extremely small study group. Cause Primary Raynaud's disease, or Primary Raynaud's, is diagnosed if the symptoms are idiopathic, that is, if they occur by themselves and not in association with other diseases. Some refer to Primary Raynaud's disease as being allergic to coldness. It often develops in young women in their teens and early adulthood. Primary Raynaud's is thought to be at least partly hereditary, although specific genes have not yet been identified. Smoking increases frequency and intensity of attacks, and there is a hormonal component. Caffeine also worsens the attacks. Sufferers are more likely to have migraines and angina. Secondary Raynaud's phenomenon, or Secondary Raynaud's, occurs secondary to a wide variety of other conditions. Secondary Raynaud's has a number of associations: Connective tissue disorders: scleroderma[7] systemic lupus erythematosus rheumatoid arthritis Sjögren's syndrome dermatomyositis polymyositis mixed connective tissue disease cold agglutinin disease Ehlers-Danlos syndrome Eating disorders: anorexia nervosa Obstructive disorders: atherosclerosis Buerger's disease Takayasu's arteritis subclavian aneurysms thoracic outlet syndrome Drugs: beta-blockers cytotoxic drugs – particularly chemotherapeutics and most especially bleomycin ciclosporin bromocriptine ergotamine sulfasalazine anthrax vaccines whose primary ingredient is the Anthrax Protective Antigen stimulant medications such as those used to treat ADHD[8] OTC psedoephedrine medications (Chlor-Trimeton, Sudafed, others) Occupation: jobs involving vibration, particularly drilling and prolonged use of a String trimmer (weed whacker), suffer from vibration white finger exposure to vinyl chloride, mercury exposure to the cold (e.g., by working as a frozen food packer) Others: physical trauma, such as that sustained in auto accidents or other traumatic events Lyme disease hypothyroidism cryoglobulinemia malignancy chronic fatigue syndrome reflex sympathetic dystrophy carpal tunnel syndrome magnesium deficiency multiple sclerosis erythromelalgia (clinically presenting as the opposite of Raynaud's, with hot and warm extremities) often co-exists in patients with Raynaud's) Raynaud's can herald these diseases by periods of more than twenty years in some cases, making it effectively their first presenting symptom. This may be the case in the CREST syndrome, of which Raynaud's is a part. Patients with Secondary Raynaud's can also have symptoms related to their underlying diseases. Raynaud's phenomenon is the initial symptom that presents for 70% of patients with scleroderma, a skin and joint disease. When Raynaud's phenomenon is limited to one hand or one foot, it is referred to as Unilateral Raynaud's. This is an uncommon form, and it is always secondary to local or regional vascular disease. It commonly progresses within several years to affect other limbs as the vascular disease progresses.

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