Blog | Tuesday, December 21, 2010

iPhone diagnosis of Raynaud's disease

Thanks to modern technology (an iPhone) a picture is worth a thousand words in diagnosing a condition. This young woman had been exercising outside by the Golden Gate Bridge in San Francisco (the temperature was a chilly 49 degrees F) and when she finished her hand looked like this:

It felt numb and began stinging when she ran hot water on it. I was not available in the office to see her so I asked her to send me a photo from her iPhone and this is what I saw.

What is seen is classic Raynaud's disease. It is a condition that causes some areas of the body like the fingers, toes, tips of nose and ears to have limited blood circulation in response to cold temperatures. It affects women more than men and the skin can turn blue or white or purple in blotchy areas. It is common to feel swelling and stinging as the circulation improves (such as immersing in hot water). An attack can last several minutes to hours.

With Raynaud's, there is a vasospasm of the small blood vessels that go to the digits. This limits blood supply which causes the skin to turn pale. Cold temperatures are most likely to trigger an attack but emotional stress can also cause it. We think it is an inherited disorder.

Most of the time, Raynaud's does not require treatment. Patients learn to avoid sudden cold (like refrigerators) and to wear gloves when it is cold outside. If the attacks are frequent or severe, medications that dilate the blood vessels can be prescribed. These are medications like nifedipine, amlodipine and felodipine.

The iPhone photo saved her from a visit to the emergency department (by when it is likely the vasoconstriction would have already resolved).

This is a form of "telemedicine."

This post originally appeared at Everything Health. Toni Brayer, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.