Raynaud’s Phenomenon: A Tale of Two Clients

They appeared to be the ideal candidates for pedicures: One was in her 20s, the other in her early 30s, and other than calluses and a corn, their feet appeared healthy. Their nail technicians — at different salons, in different communities — didn’t think twice about using a Credo blade to shave away the top layers of dead skin from the calluses and corn. Both nail techs accidentally nicked these clients, but the wounds appeared so minor that the nail technicians didn’t even bother to mention them.

Unfortunately, neither nail technician questioned the women’s health histories, nor did these clients think to mention that they have Raynaud’s Phenomenon. Characterized by blood vessels in the hands and feet that spasm and temporarily cut off blood flow to the digits, Raynaud’s Phenomenon most commonly strikes otherwise healthy women ages 20-40. Triggered by exposure to cold, the spasms usually last just a few minutes to a few hours.

Soon after their respective pedicures, each woman experienced an episode of Raynaud’s. When the blood flow returned to the younger woman’s injured toe, it began to bleed uncontrollably, spurring a visit to an urgent care center for treatment. At a follow-up visit with her podiatrist a few days later, she told him she intended to sue the nail technician.

By coincidence, around this same time the other woman sought treatment from the same podiatrist for a progressively worsening infection on her cut foot. She, too, had linked the original injury to the pedicure. She angrily told the podiatrist that her next appointment was with her lawyer.

Raynaud’s Phenomenon typically causes nothing more than color changes to the affected digits accompanied by temporary numbness, tingling, or discomfort in the fingers or toes. "Raynaud’s is related to the person’s amount of cold exposure," says Doug Albreski, M.D., director of the podiatric clinical dermatology section at the University of Connecticut Health Outer, where he is a full-time clinician and associate professor. "It’s fairly benign in most people."

People with Raynaud’s have a higher risk for infection due to poor circulation in their extremities during a spasm. Unless you see the hands or feet during a spasm, there are no obvious indicators of the condition. In fact, some people don’t even know they have it, and even those who do may never think to mention it because it seems so innocuous. But as these women’s experiences proved, Raynaud’s Phenomenon is a condition that should rank high on every tech’s "watch list."

Raynaud’s: An Over-Reaction

Both primary and secondary Raynaud’s Phenomenon stem from an exaggerated response of the vascular system to cold, though smoking and stress can also trigger the response.

The body’s normal response to cold is to slow its loss of heat and to preserve its core temperature, explain researchers at the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) in the publication, Questions and Answers About Raynaud’s Phenomenon. While a person may consciously respond to cold by donning a sweater or gloves, her neurological system signals the vascular system to redirect blood from veins and arteries near the skin to ones deeper in the body.

In people with Raynaud’s, the blood vessels that supply blood to the lingers and toes overreact to this message and constrict, or spasm. The result is that oxygenated blood can’t reach the fingers or toes.

"With no blood going to the fingers or toes, they turn while [also known as pallor]," says Dr. Albreski. "The next step is that the veins [in the fingers or toes] will dilate. As the deoxygenated blood pools in the veins, the fingers or toes can take on a blue hue, which is termed cyanosis."

When the spasm spontaneously ends, fresh, oxygenated blood floods the blood vessels. Because these vessels are still dilated, the affected fingers or toes may turn red and feel warm.

Along with the color changes (which not everyone will experience), people with Raynaud’s may also experience a tingling, "pins and needles" sensation in the affected area as well as a partial loss of feeling or numbness. For some, the episodes cause pain.

Spasms typically last a few minutes to a few hours. Skin can remain healthy without oxygenated blood for two to two and a half hours, so tissue death is a rare, extreme result.

There’s no cure for Raynaud’s, so the treatment goal is to reduce the number and severity of attacks and to prevent tissue damage and loss. According to Dr. Albreski, reducing episodes of Raynaud’s can be as simple as avoiding cold. He advises people with the condition to wear hats and mittens in cold weather and to keep their fee well-protected with thick socks and shoes.

Remember that it doesn’t have to be freezing outside to trigger Raynaud’s. Any heat loss can trigger the reaction: air-conditioning, immersing the hands or feel in cold water, or even reaching into the freezer. The trick, Dr. Albreski says, is to wear layers and to add and subtract garments with the rise and fall of the temperature.

When Raynaud’s attacks occur, NIAMS recommends counter-attacking by warming the hands or feet. Head to a warmer area, and run warm water over the fingers or toes, or soak them in a bowl of warm water. Stress can trigger or worsen an attack, so sufferers should make a conscious effort to relax by whatever means they find most effective. Deep breathing, visualization techniques, or listening to soothing music are just a few favorites. Regular exercise may also help by improving circulation and reducing stress. People with the secondary form may be prescribed medications to relax or dilate blood vessels such as calcium-channel blockers, alpha blockers, or vasodilators.

Salon Clients Fit the Profile

As many as 5%-10% of Americans have Raynaud’s Phenomenon, according to NIAMS. Odds are, the percentage of your salon clients who have the condition are even higher because the condition primarily affects otherwise healthy women between the ages of 20 and 40.

There’s no test to diagnose Raynaud’s Phenomenon, so a physician usually makes the call based on the described symptoms and a history of episodic occurrences over a two-year period. However, the doctor still may run tests to determine if the condition is primary or secondary. The most common form, primary Raynaud’s Phenomenon, has no known cause. Secondary Raynaud’s Phenomenon is far less common but tends to be more serious.

According to NIAMS, connective tissue diseases [including scleroderma and lupus] are the most common cause of secondary Raynaud’s Phenomenon. People with rheumatoid arthritis also have a higher risk of developing secondary Raynaud’s.

Secondary Raynaud’s is considered more serious because it tends to worsen over time with more frequent and more severe attacks. "With scleroderma, for example, the blood vessels thicken, which decreases the flow of blood throughout the body," explains Dr. Albreski. The decreased blood flow triggers the neurological system to increase the supply of blood to "essential" organs, such as the heart, at the expense of the hands and feet. As the scleroderma worsens, the blood vessels in the hands and feel spasm more frequently. The decreased blood flow to the fingers and toes can cause poor circulation in those areas, which in turn heightens risk of tissue death and gangrene.

Other known risk factors for developing Raynaud’s include a history of migraine headaches, smoking, alcohol abuse, and some occupational hazards (such as working with high-vibration equipment like a jackhammer).

Proceed With Caution

"I don’t think [Raynaud’s] is a contraindication lor nail services, but I think nail technicians should be aware if a client has it and to never cut the skin," Dr. Albreski says. Ask if they have the condition as part of the initial consultation, but also screen them by asking if they have the symptoms in case they don’t know what they’ve got. "A good screening question would be to ask if their fingers or toes change colors when it’s cold outside," he suggests.

Rather than cut the skin or debride calluses and corns with any metal implement, Dr. Albreski recommends sloughing dead skin cells with exfoliants, files, and pumice stones. He also cautions against any cold or cooling therapies on clients you suspect may have Raynaud’s because they could trigger an event.

If you accidentally break a client’s skin, consider honesty your best policy. "Make the client aware of the injury, then clean the area and make sure the bleeding is stopped," Dr. Albreski says. The two women with Raynaud’s who had bad results from pedicures, for example, told the podiatrist they would have taken proactive steps themselves if they had known about the cuts.

Next, learn the accepted practices for wound care and keep a well-stocked first aid kit at hand. Laura Roehrick, R.N., proprietor of The Foot Care Nurse in Santa Rosa, Calif, advises washing the cut and surrounding area with warm, soapy water and drying it well. "Wound care nurses wouldn’t recommend an antibiotic ointment because they believe the ointment attracts moisture," she comments. Ditto for bandages because they can trap moisture, which provides an idea environment for bacterial growth.

Opinions vary, however. "I can read five million articles and get five million opinions," Roehrick adds with a laugh. Consult with your physician for the best approach, and know that what’s best for the hands may not be the same for the feet.

Roehrick also urges nail techs to consider taking the extra step to sterilize implements. "Autoclave sterilization is easier on your instruments, and in these days where people are sue-happy, it’s not an extreme idea," she says. However, others argue that the disinfection methods mandated by most state boards are entirely sufficient and that sterilization actually can intimidate clients. You make the call based on your clients’ needs.

Health Before Beauty

Raynaud’s Phenomenon — and, indeed, peripheral vascular diseases in general — are just one of many medical conditions that nail techs may encounter during a nail service. Nor will every client be aware of, or admit to, having a condition. Review — and practice faithfully — proper sanitation and disinfection procedures as well as basic first-aid measures for nicks and cuts. ‘Then, familiarize yourself with the medical conditions that contraindicate nail services or that warrant precautionary measures, and eliminate invasive cutting procedures (which most states limit to licensed medical professionals, anyway).