Hyperthermia to address Raynaud's phenomenon

Preventing the development of digital ulcers

Raynaud's phenomenon is a term that refers to color changes (blue, white, and red) that occur in the fingers and sometimes the toes. Raynaud's syndrome usually appears after exposure to cold temperatures. It happens when blood flow to the hands, fingers, or toes is temporarily reduced. Raynaud's can lead to finger swelling, color changes, numbness, pain, skin ulcers, and gangrene in the fingers and toes. People with Raynaud's disease may have other diseases, and some people with Raynaud's may not have any other diseases.

In patients diagnosed with scleroderma, Raynaud's phenomenon, digital ulcers, and calcinosis are common manifestations. Digital ulcers occur in more than half of patients.

Raynaud's phenomenon occurs in two main forms:

• Primary Raynaud's is the most common form of the disorder and is not connected to an underlying disease or related medical problem.
• Secondary Raynaud's is caused by an underlying or related problem. Secondary Raynaud's is less common than the primary form, but tends to be a more serious disorder.

Symptoms of secondary Raynaud's often first appear later in life, around age 40, while people with the primary form usually have symptoms earlier.

Causes of Raynaud's phenomenon

The blood vessels in the hands and feet appear to overreact to cold temperatures or stress. When the body is exposed to cold temperatures, the hands and feet can lose heat. The body slows down the blood supply to the fingers or toes to preserve core temperature. It specifically reduces blood flow by narrowing the small arteries under the skin of the fingers. In people with Raynaud's, this normal response is exaggerated. Stress causes a reaction similar to cold.

In Raynaud's, the arteries in the fingers enter a state called vasospasm. Vasospasm occurs when blood vessel spasms cause the blood vessels to narrow, critically and temporarily limiting blood supply.

These same small arteries may thicken slightly, further limiting blood flow. The affected skin becomes pale and dark in color due to the lack of blood flow to the area. Once the spasms subside and blood returns to the area, the tissue may turn red before returning to its normal skin color.

Cold temperatures are more likely to trigger an attack. Exposure to cold can be as simple as putting your hands under a cold running tap, taking food out of the freezer, or being exposed to cold air. For some people, exposure to cold temperatures is not necessary. Emotional stress alone can cause a Raynaud's episode. Raynaud's syndrome may be partly a hereditary disorder.

The causes of secondary Raynaud's include:

• Scleroderma
• Lupus
• Rheumatoid arthritis
• Sjögren's syndrome
• Carpal tunnel syndrome
• Arterial diseases, such as atherosclerosis
• Injuries due to overuse
• Smoking
• Injuries to the hands and feet
• Certain medications, such as beta-blockers, which are used to treat high blood pressure; migraine medications containing ergotamine; medications containing estrogen; certain chemotherapy drugs; and medications that can narrow blood vessels.
• Chemical exposure: People exposed to vinyl chloride, such as those working in the plastics industry, may develop a disease similar to scleroderma. Raynaud's phenomenon may be part of this disease.
• Thyroid gland disorders

Treatment of Raynaud's phenomenon: hyperthermia

Prevention

Care and preventive measures, such as wearing gloves or heavy socks, are usually effective in treating mild symptoms of Raynaud's. If these are inadequate, medications are available to treat more severe forms of the disease. The goals of treatment are:

• Reduce the number and severity of attacks
• Prevent tissue damage
• Treat any underlying disease or condition

Medications

Depending on the cause of the symptoms, medications can help treat Raynaud's syndrome. To widen (dilate) blood vessels and promote circulation, your doctor may prescribe:

• Calcium channel blockers: These drugs relax and open small blood vessels in the hands and feet. They reduce the frequency and severity of attacks in most people with Raynaud's. These medications can also help heal skin ulcers on the fingers.
• Alpha blockers: Some people find relief with medications called alpha blockers, which counteract the actions of norepinephrine, a hormone that constricts blood vessels.
• PDE-5 inhibitors: These drugs can effectively relieve Raynaud's symptoms. These drugs include the high blood pressure medication losartan (Cozaar), the erectile dysfunction medication sildenafil (Viagra, Revatio), the antidepressant medication fluoxetine (Prozac, Sarafem), and a class of medications called prostaglandins.

Surgeries and medical procedures

In cases of severe Raynaud's, medications may be inadequate, so your doctor may explore other treatment options:

• Nerve surgery: Nerves called sympathetic nerves in your hands and feet control the opening and narrowing of blood vessels in your skin. In severe cases of Raynaud's, it may be necessary to cut these nerves to interrupt an exaggerated response. Through small incisions in the affected hands or feet, a doctor pulls away these tiny nerves around the blood vessels. The surgery, called sympathectomy, can reduce the frequency and duration of attacks, but it is not always successful.
• Chemical injection: Doctors may inject chemicals to block the sympathetic nerves in the affected hands or feet. You may need to repeat the procedure if symptoms return or persist.
• Amputation: Sometimes, doctors need to remove tissue that has been damaged by a lack of blood supply. This may include amputation of a finger or toe affected by Raynaud's disease where the blood supply has been completely blocked and the tissue has developed gangrene. This surgery is used very rarely.

Hyperthermia

Hyperthermia, a heat radiation method that uses infrared A rays and filtered water to raise body temperature, promotes rapid heat distribution throughout the body while only slightly affecting the epidermis.

Hyperthermia has been shown to be indicated for treating systemic scleroderma (AKT DERMATOL 1993) and reducing Raynaud's phenomenon.

At Biosalud Day Hospital, we have a total body hyperthermia bed for complementary treatments for cancer or chronic infections, which is unique in Spain.

We have been treating autoimmune diseases of this type for some time, in which the body produces an auto-attack response from the immune system against the body itself.