Raynaud's syndrome and scleroderma
Raynaud’s syndrome is a common condition when the blood supply to the extremities is interrupted or reduced. This usually affects the fingers and toes, but sometimes the nose or ears.
Attacks are usually caused by cold or a sudden change in temperature. During an attack, the affected part changes colour. First it becomes pale, then it turns blue as the tissues use up the oxygen, and finally bright red as the arteries relax and fresh blood rushes in. Pale skin can appear red, but this might be harder to see on black or brown skin.
Raynaud’s can vary from very mild, to severe and requiring treatment. Anyone can suffer from Raynaud’s, but younger women are affected more often. It seems to be caused by a change in temperature rather than just cold exposure, so although Raynaud’s is worse in winter, attacks can happen in summer.
Stress or anxiety can also cause a Raynaud’s attack. Some cases of Raynaud’s are associated with other conditions. This is called ‘secondary Raynaud’s’.
The NHS site has more information about Raynaud’s syndrome.
Almost all people (more than 9 out of 10) with scleroderma have Raynaud’s syndrome, but there is only a small chance of someone with Raynaud’s getting scleroderma. On average, this happens in less than 2 in 100 women, and less than 6 in 100 men.
The word scleroderma means ‘hardening of the skin’, but the condition is not limited to the skin. It affects the connective tissue that holds our bodies together. This means that the internal organs can also be affected.
Most people with scleroderma have the mild form (localised scleroderma), where the skin becomes stiff and shiny, and usually affects the hands and feet. The food pipe (oesophagus) might also be affected, making eating and swallowing difficult. This can be divided into 2 types.
Localised scleroderma (morphea)
This only affects the skin and there is no spread inside the body. The changes to the skin can last for many years before they get better.
These band-like lesions can cause thickened skin in lines, mostly on the arms and legs of children, but also on the forehead and scalp. They can affect the tissue and joint underneath the lesion.
In some people, tiny deposits of calcium can form under the skin (calcinosis), which can cause ulcers (sores).
In its more severe form (diffuse scleroderma), wide areas of skin and internal organs, such as the lungs, bowel, heart and kidneys, are affected.
The NHS has more information about scleroderma.
Diagnosing Raynaud’s syndrome
Your medical history is the most important consideration. Blood tests might help, and so can a nail fold capillaroscopy. This is when we examine the small blood vessels at the base of your nail.
Family medical history
There is no evidence that Raynaud’s or scleroderma are inherited (passed to you by your parents). However. if you have a relative who has the condition, you are more likely to be affected.
Your GP or specialist might prescribe a vasodilator, which is a medicine that relaxes your blood vessels. Sometimes, your specialist might recommend surgery, called a sympathectomy. This involves cutting or destroying the nerves that are causing the arteries to tighten.
This operation is more successful for Raynaud’s in the feet. It is not recommended for most people with Raynaud’s, as it does not usually produce long-term benefits.
A lot of people who develop Raynaud’s as teenagers have a form that is benign (harmless and not associated with any other condition) and disappears with age.
There is no cure for scleroderma, but there are many treatments available to ease specific symptoms. As everyone is different, and your Raynaud’s will be individual to you, you should discuss any issues with your doctor.
How you can help yourself
There are things you can do which might help. The most important are to stop smoking, take regular exercise, and keep warm.
If you are a smoker you should give up completely. Tobacco is harmful as it causes the blood vessels to constrict, decreasing the blood flow to the fingertips. Your GP should be able to discuss strategies for you to give up smoking, or arrange for you to see a stop smoking counsellor.
Nicotine-replacement therapies might help, and you should discuss this with your doctor or pharmacist. If you would like to give up smoking, please speak to your nurse or call our Stop Smoking service, phone 020 7188 0995, or the NHS Smoking Helpline, phone 0300 123 1044.
Eating for warmth
Eating and drinking can help you keep warm. Try to eat lots of small meals to maintain your energy. High protein foods (milk, meat, fish and fresh vegetables) are best. Hot meals and plenty of hot drinks are essential.
Gentle exercise will help your circulation. Try to avoid sitting for long periods. Get up and walk around the room, moving arms and legs to maintain good circulation. Do not let your fingers or toes get cold. In cold weather take exercise indoors, if possible.
Tight clothing should be avoided as it can restrict blood flow. Hands and feet should always be adequately covered. A scarf should be used to keep your face warm in cold weather, and a hat and several layers of clothing should be used to keep your head and body warm.
Feet can easily get cold, so a thick pair of socks is essential. Wet shoes and clothes should be changed as soon as possible.
Things that can make Raynaud’s symptoms worse
If you are prescribed any medicines and you get Raynaud’s-type symptoms, check with your GP who might be able to change your medicine. Medicines that can make symptoms worse, include some:
- beta blockers (for high blood pressure)
- migraine medicines
- contraceptive pills
- attention deficit hyperactivity disorder (ADHD) medicines
- cancer medicines
- medicines that affect the blood vessels
- medicines for cold symptoms
Some other substances that make symptoms worse include:
- tobacco (smoking)
- being close to certain chemicals, such as vinyl chloride (found in some cleaners and hair products)
Vibration white finger (VWF)
People who work with vibrating tools are more likely to develop Raynaud’s, especially if the vibration is coarse and low frequency. This can become permanent even after the work has stopped. VWF is an industrial condition, and you might be eligible for compensation.
These usually appear on the extremities (fingers, toes and ears). The skin might first become itchy, then red, swollen and very tender to the touch. The redness might be harder to see on black or brown skin. Chilblains happen as a result of bad circulation on exposure to cold. Clothing that rubs should be avoided.
This is arthritis that affects the lining of the joints. The lining produces a fluid that lubricates the joint and, when affected by rheumatoid arthritis, it becomes inflamed. More fluid is produced causing a red, painful, swollen joint. About 1 in 10 people with rheumatoid arthritis have secondary Raynaud’s.
Lupus (systemic lupus erythematosis)
Symptoms of lupus include a rash sometimes seen on both cheeks, and the bridge of the nose, and chronic inflammation of the blood vessels and connective tissues of the body. There is associated tiredness, joint pain, mouth ulcers, hair loss, and Raynaud’s.
This is a rare condition where excess blood flow causes symptoms to flare up. It’s a life-long condition which mainly affects the feet and lower legs. Symptoms often include:
- persistent warmth
- burning pain
Symptoms continue to get worse. Most people with erythromyalgia also have some symptoms associated with Raynaud’s.
The NHS has more information about erythromyalgia.