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Idiopathic Paroxysmal Digital Cyanosis
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- Raynaud's Disease is
a disease process that causes the fingertips to turn white
or blue when exposed to cold or when one is under stress. It
is caused by reduced circulation to the fingers because the
blood vessels tighten (or constrict). Young women are most
commonly afflicted. It is usually a mild disease that does
not cause severe problems.
- Raynaud's affects the circulation,
most often of otherwise healthy, young women, usually
between 15 and 45 years old. The main symptom involves the
fingertips turning very white (or occasionally blue) when
exposed to cold, or when one is under emotional stress. The
fingers then turn red when re-warmed. There may be some pain
or numbness. The disease is usually mild and, in most cases,
does not cause any permanent problems. Treatment is mainly
to keep the hands warm.
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- Most people with this disease
notice that their hands turn very white (or perhaps even
blue) when they are exposed to cold conditions or when they
are under a lot of stress.
- The process usually affects the
fingers, but may also affect the toes.
- Initially, only one or two fingers
may be affected. However, eventually it will affect the
other fingers and sometimes even the palms. The thumbs
usually are not involved.
- The disease usually affects both
hands, not just one hand.
- Symptoms either go away by
themselves or when the hands are re-warmed, for example with
a heater or with hot water.
- Once the hands are re-warmed, they
usually turn very red.
- Some people may notice pain,
numbness, stiffness, or swelling as the symptoms disappear.
- In between attacks, there are
usually no symptoms at all.
- When the pulses are checked, they
are normal. The arteries supplying the hands are fine and
are not narrowed. Rather, the problem is that the blood
vessels spasm and contract when exposed to cold or when the
person is under stress.
- If the condition is very severe,
ulcers may form on the fingertips or the muscles, and skin
in the fingertips may become weak and atrophied.
- Symptoms of Raynaud's Disease may
slowly get worse. The episodes of the hands turning white
may occur more often and last longer.
- Symptoms usually disappear when the
weather becomes
warmer.
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- It is not clear what causes Raynaud's Disease.
Basically, the blood vessels tighten up and there is reduced
circulation to the fingers. It is believed that there is
some nerve involvement as a causal factor. However, this has
not been conclusively proven.
- Others feel that there may be some
relation to an infection caused by a bacterium known as
Helicobacter pylori. However, this is still being
studied. (Need to check with a
rheumatologist.)
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- Primarily based on symptoms
- There are no specific tests for the
disease.
- However, tests to rule out other
diseases usually need to be done.
- If the symptoms fit and the person
has symptoms for more than 3 years without developing
another disease, then the diagnosis can be made.
- Most blood tests are normal in people with Raynaud's Disease.
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- There are no specific risk factors
other than exposure to cold or emotional stress. We are
still not sure what causes the disease.
- It is believed that smoking may
worsen the disease.
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- The primary treatment is to keep
the hands warm. Protect them from exposure to cold.
- Also, hands should be protected
from any injury. Due to the problems with circulation,
wounds heal more slowly in people with this disease. If an
infection does occur, it is harder to treat because of
reduced circulation.
- Lotions and moisturizers should be
used to keep the hands and fingertips moist.
- If you smoke, you must stop
immediately.
- Medication can be tried when the
above measures are not effective. However, the response to
medications varies from person-to-person.
- Nitroglycerin - this can be taken
as a pill or applied as a patch. In a few cases,
nitroglycerin ointment applied directly to the fingers has
been tried with some success. However, this is not very
practical.
- Nifedipine - this medicine is
generally used to control blood pressure. It can also be
used to treat the disease, but, once again, results vary
from person-to-person.
- Sympathectomy - this is a type of
surgery. If the condition becomes very severe and
medications are not working, then surgery can be done to cut
the nerves that cause the blood vessels to tighten (or
constrict). This will let the blood vessels dilate and help
improve circulation. However, in many cases, the body adapts
after a few years and the symptoms reappear. This is truer
in the hands. In the feet, surgery usually results in a more
permanent solution. If the symptoms do reappear, they are
often not as severe.
- Most cases of Raynaud's Disease are
not severe. It usually only causes mild symptoms. In a few
cases, however, the disease may get worse fairly rapidly and
lead to more severe symptoms-- causing significant
disability.
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- Formation of ulcers on the
fingertips
- Numbness or tingling
- Pain
- Weakening of the muscles of the
hand
- The skin may thin and weaken.
- Stiffening of the
joints
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- Seek medical attention.
- Also, try to keep your hands warm
as much as possible.
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- There is no real way to prevent
this disease. You can try to reduce the symptoms by avoiding
exposure to cold.
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