Differentiating Acrocyanosis From Raynaud's Phenomenon

Differentiating Acrocyanosis From Raynaud's Phenomenon

“Cold hands, warm heart.” 

The above expression is heard countless times by people with Raynaud's phenomenon and acrocyanosis. Both autoimmune disorders are caused by deoxygenated capillaries and venules of the extremities. As a result, temperature for hands or feet may drop as low as 70 degrees Fahrenheit (clinically) — nearly 30 degrees cooler than the average core body temperature. (Sidebar: Watch realtime video of hand temperature dropping to 46.9 degrees.) Though quite rare, unchecked, prolonged deoxygenated extremities can lead to ischemic gangrene with possible limb amputation.

Causes and Symptoms

Bluish sweaty hands or feet (cyanosis) are characteristic of acrocyanosis. Raynaud's phenomenon is distinguished by additional white (blanching) vasoconstriction and red (hyperemic) rewarming coloration phases, usually in the absence of perspiration. Fingernail abnormalities such as flattening, severe arching, fingernail splinter hemorrhages, and striations may also be evident among those with Raynaud's phenomenon.

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Generally hereditary, Raynaud's phenomenon, named after the research of French physician Maurice Raynaud (1834-1881), may also affect the nose and earlobes. It is more common among women, affecting 8 percent of the population verses 5 percent of men.

Episodes accompanied by numbness or pain can be brought upon by emotional stress or cool (not necessarily cold) organic and inorganic temperatures. It is as if the body's "thermostat" is malfunctioning — signaling the immune system to preserve blood flow to core internal organs, as is the case during hypothermia. The autonomic response is not limited to the winter season. Episodes may occur in the Spring or as result of air conditioning in the Summer. Since stress is a factor, episodes of 30 minutes or more may occur at any time.

A striking physical feature in Postural Orthostatic Tachycardia Syndrome (POTS) is acrocyanosis with the gross change in extremity skin color that can occur with standing.

Acrocyanosis or Raynaud's disease can be self-limiting. Primary Raynaud's phenomenon, however, may also be present in, or a precursor to, additional autoimmune disorders such as secondary Raynaud's syndrome, skin atrophy, dermal ulceration or papules, dermatomyositis, rheumatoid arthritis, Sjögren's syndrome, vasculitis, or scleroderma.

Treatment

Non-medical precautions and temporary remedies include:

• Reducing stressful situations
• Submerging hands in warm water
• Wearing multi-layer or fir-lined gloves
• Wearing warm socks on feet
• Warm clothing on trunk and head
• Adjunctive handwarmers
• Residential relocation to warm climate
• Avoid work in snow or freezers

Since Raynaud's disease is really a symptom, treatment focuses on identifying and treating primary ailments as well as reducing discomfort. This is generally managed by a rheumatologist. Drugs that block calcium uptake (calcium channel blockers) and alpha-one antagonists may be prescribed. In extreme cases, minimally invasive Micro ETS (endoscopic thoracic sympathectomy) surgery may be performed. In some cases, hypothyroidism can trigger symptoms of Raynaud's disease.

Tags: chills, dermatology, differential, freezing, photos, rheumatology, symptoms

References

1. Read about Micro ETS™ and Raynaud's phenomenon treatment by David H Nielson, MD.
2. Brr! Disorder makes some super sensitive to cold. The Body Odd. bodyodd.msnbc.msn.com
3. Nail Abnormalities: Clues to Systemic Disease. American Family Physcian, aafp.org
4. What is a Splinter Hemorrhage? Nails Magazine Online, nailsmag.com