Behavioral Treatment of Raynaud’s Syndrome

Abstract

Raynaud’s Disease is a syndrome of disrupted peripheral bloodflow first described by Maurice Raynaud in 1862. A triphasic color change, usually exhibited in the digits of the hands or feet, is the hallmark of the disorder: sudden blanching and numbness of the affected part, due to localized arteriolar constriction; cyanosis, in which the pallor previously observed evolves into a blue color, characteristic of deoxygenated tissue and attributed to retarded blood flow in dilated capillaries and venules; and reactive hyperemia, characterized by the spread of red oxygenated blood through the upper level of the epidermis. This last phase is often accompanied by burning and tingling and lasts until the skin returns to its normal pink color. Only a minority of patients actually exhibit the classic triphasic color change, however, isolated pallor or cyanosis are much more likely (Porter, Rivers, Anders, & Baur, 1981). Typically, ischemia starts in the fingertips and progresses proximally to a variable degree, but rarely involves the palm. Occasionally, the earlobes, cheeks, and tip of the nose may also be affected (Hoffman, 1980). Attacks may last from minutes to hours and usually involve a local sensation of coldness, a loss of manual dexterity and considerable pain that can result in the interruption of routine activity. In severe cases, patients experience chronic vasoconstriction or such frequent episodes of cyanosis that gangrene or small nutritive lesions and ulcerations can appear at the distal end of the digits. Although cold stimulation is the most reliable eliciting stimulus, emotional stress has also been reported to produce these attacks (e.g., Mittlemann & Wolff, 1939).