Why is my toe white
Raynaud’s Phenomenon : What You Should Know | Johns Hopkins Medicine
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- Raynaud's is a condition that results
in decreased blood flow to your fingers and toes
when you're exposed to cold, stress,
or changes in relative temperature.
(gentle piano music)
It can cause symptoms of numbness or tingling
to the affected areas and cause a color change
in your fingers to white, blue,
and then often a red discoloration
that follows the episode.
Patients can be affected who don't have
another connective tissue disease
and typically that type of Raynaud's
is called Primary Raynaud's and it mainly affects
young women in their teens and 20s.
Symptoms typically improve over time.
Many patients often have full resolution of symptoms
by the time they're in their 30s or 40s.
However, there's a second type of Raynaud's
called Secondary Raynaud's that affects patients
with connective tissue diseases such as scleroderma,
lupus, rheumatoid arthritis, vasculitis, and others.
That's the type of Raynaud's that tends to be
later in onset, usually after the age of 30.
It also affects more women than men and can be associated
with some more significant complications.
For example in Primary Raynaud's patients don't typically
tend to have ulcers on the tips of their fingers
or lose fingers as a consequence of their cold exposure.
But, in Secondary Raynaud's, that can happen.
So, patients who have Raynaud's as a consequence
of another disease have to be a little bit more careful.
In both situations, the Raynaud's can be managed
by staying warm, avoiding triggers such as stress
and changes in relative temperature
and carrying around HotHands or the little packets
that warm your fingers to keep handy
when your fingers start to spasm.
Sometimes running the hands under warm water
can also be helpful in resolving the episode.
Patients who have Primary Raynaud's
usually have normal blood studies
so they don't usually have antibodies
or other abnormalities in their blood.
But, patients with Secondary Raynaud's
usually have some sort of abnormality
either on the blood tests, physical exam, or both.
And, this will usually tell the doctor
that there's something else that's ongoing
that should be investigated.
When you have Secondary Raynaud's,
it can be important sometimes to take medication
to help those symptoms.
Not in everybody, but if you're experiencing
more symptoms then that can be helpful.
So, for example, if you're experiencing ulcers
on the tips of your finger, or have little indentations
at the tips of the fingers called digital pits,
or if you have even more significant damage
to the finger, then your doctor will probably
want to put you on a medication
called a calcium channel blocker,
such as nifedipine, amlodipine, or felodipine.
These medications can be helpful in dilating blood vessels
to maximize the blood flow to the tips
of the fingers and toes.
There are other medications that can be helpful
such as phosphodiesterase inhibitors
meaning medications like Viagra or Cialis.
Those also improve blood flow to the fingers and toes.
And, medications for pulmonary hypertension
would also benefit the Raynaud's.
Some patients have a challenge in the sense
that their blood pressures run low
so dilating the blood vessels further
can exacerbate the low blood pressure.
But, in such a situation there are other options.
We work closely with our plastic surgeons
and hand specialists where they can inject Botox
into the fingers which can be helpful in some patients
in dilating the blood vessels locally,
but not affecting systemic blood pressures.
In addition, there are topical agents
like topical nitroglycerin that can be helpful.
Medications such as selective serotonin
receptor uptake inhibitors or SSRIs
which are also used to mange stress and mood
and those has been shown to be helpful
in Raynaud's as well.
And, medications such as statins which actually
are known for their ability to control cholesterol
also may have a beneficial effect
in patients with Raynaud's as well.
If Raynaud's presents after the age of 30 or so,
it's definitely something that you should talk about
with your physician.
Raynaud's will present with pallor of the fingers,
meaning that the fingers will look like
they've either been dipped in white ink
or blue ink.
It's not a mottled or speckled pattern
of white or blue and it's definitely
not something that only affects the fingernails.
But, if you do have those signs of pallor
or blue discoloration of the fingers
after the age of 30, you should go
and speak with your doctor because it could be
an early sign of something else that's going on
in your body such as another autoimmune disease,
thyroid disease, et cetera.
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