In the past week, I have spoken to four people who have said that their hands get white and very painful when they get a little cold. This seems to go beyond the simple “cold hands and feet” that we all get from time to time. This condition may be referred to as Raynaud’s phenomenon.
Raynaud’s occurs when the small blood vessels in the hands, feet and other parts of the body constrict or begin to spasm in response to cold temperature. This response can be elicited by something as benign as running the body part under cold water or by pulling something out of the freezer.
When the blood vessels under the skin constrict or spasm, the blood flow to the affected
body part is essentially cut-off. This results in discoloration and pain. If the blood flow continues to be interrupted, the tissue will die, resulting in disfigurement or possible need for amputation.
Raynaud’s is more common in women than in men. Other factors that seem to predispose people to this condition are living in cold climates, scleroderma, lupus, repetitive occupational movements, carpal tunnel syndrome, smoking and exposure to certain chemicals such as vinyl chloride. Some medications can exacerbate Raynaud’s symptoms including some cough and cold medications, birth control pills and some blood pressure/heart medications such as beta blockers.
Treatment can be as simple as avoiding the cold condition that causes the spasms. A good pair of mittens combined with a pair of hand warmers may prevent Raynaud’s in the hands. Wearing warm boots with warm socks combined with toe warmers may prevent Raynaud’s in the feet.
Medications that stop the spasms and constrictions of the blood vessels can be very helpful in treating this condition. The mainstay of treatment are drugs that dilate the blood vessels. First-line therapy drugs include calcium channel blockers including nifedipine or diltiazem. Other drugs that can be used include direct vasodilators such as nitroglycerine or drugs that counteract adrenaline in the blood vessels (also known as alpha blockers including prazosin or doxazosin).
Taking these medications by mouth may not be effective to treat Raynaud’s because the drugs will not be able to accumulate in sufficient concentration at the site to prevent the constriction or spasm. In addition, taking these medications by mouth may be fraught with unpleasant side effects.
Application of these drugs in a cream directly to the affected area(s) is often much more effective than oral therapy. Topical application may be effective in warding off the painful and disfiguring effects of Raynaud’s syndrome. Call Keystone Pharmacy. We may be able to help.
by David J. Miller, RPh, PhD, FIACP
Example of a patient with Raynaud’s Syndrome. Notice how the fingertips are blanched because the blood vessels constrict and spasm.