Systemic Diseases and Vascular Disorders
Causes
People with diseases such as diabetes, high blood pressure, or kidney failure can be more likely to have vessel problems. Working with vibrating tools, being in cold temperatures, and smoking can worsen vascular problems.
Vascular Disorders usually fit into one of 5 groups:
Traumatic: occur due to injury or trauma
Compressive: occur when the pipes flatten
Occlusive: occur when pipes are blocked
Tumors (growths) or malformations (deformed, tangled pipes): may or may not be present at birth
Vessel spasms, which occur when abnormal control of vessels causes them to narrow
Signs and Symptoms
Vascular Disorders can include:
Pain
Abnormal color changes in the fingertips
Ulcers or wounds that do not heal
Hand problems when in cold temperatures or locations
Numbness or tingling of the fingertips
Swelling
Cool or cold fingers and/or hands
Systemic Diseases can include:
Arthritic Swelling
Arthritic swelling of the middle joint of a finger is called a Bouchard's node. The swellings at the small finger joints are called Heberden's nodes.
Buerger's Disease
This is one type of occlusive vascular disease that may affect the fingers. It is due to an inflammatory disease called vasculitis and is typically associated with smoking. This disease affects the medium and small arteries, so it often affects the fingers and toes. The disease may present as a painful and poorly healing wound or ulcer/gangrene at the fingertip. Involvement of multiple fingers is common. The primary treatment is to avoid smoking. Amputation is sometimes necessary.
Dactylitis
This case of dactylitis was associated with psoriatic arthritis. In this photo, the swelling extends from the palm to include the ring finger out to the small joint. Stiffness is common. There also may be pain. This swelling may be improved with medicines for the problem causing it.
Mucous Cyst
This type of cyst is called a mucous cyst. If the skin becomes thin, the cyst may break resulting in drainage of a clear sticky fluid. The resulting break in the skin may allow bacteria to reach the nearby joint, causing a joint or bone infection.
Red Dots
The small red dots seen above are in the thin part of the skin around the nail. They may also occur in the thicker pink part. This has been seen in dermatomyositis, systemic lupus, and scleroderma.
Leukonychia
Leukonychia can be seen with viral infections, intestinal and kidney diseases, poisoning, and medicines. The nail may come loose from the nail bed because of fungal infections or other causes.
Red Streaks
Red streaks seen in the fingernail area can be due to hemorrhage (bleeding). These are called splinter hemorrhages and have been seen in endocarditis (heart infection), although also reported in psoriasis, and trichinosis.
Psoriasis
Psoriasis commonly affects the nail and nail bed. Pits in the nail, loosening, blood streaks beneath the nail, and other changes may occur. A psoriasis skin patch is seen in the middle.
Pincer Nail
This Pincer nail with an abnormal side-to-side shape curve can be seen at birth or simply due to aging. However, it can also be caused by changes in the bone beneath because of disease (gout in this case).
Pyogenic Granuloma
This is a fleshy, moist, easily bleeding mass/lump that can affect the fingers, although it has been reported in many other body areas. In the fingers, it is commonly found after trauma to the skin. If there are multiple or recurring lumps, it may be due to the effects of medications or pregnancy. The most effective treatment is surgery to remove the lump, but if it is due to medication, stopping the use of the medication can help.
Terry's Nails
Fingernails will appear milky white/opaque, except for a small band of pink/red at the end of the nail bed. This appearance was first reported to be associated with liver disease and has also been reported with congestive heart failure, type II diabetes and aging.
TREATMENT
Treatment will vary depending on the condition:
Trauma
Traumatic injuries can cause a vessel to be partially or completely cut, such as from a knife wound. The vessel can be hit or stretched badly enough to damage its lining and cause a blood clot. Poor blood flow after trauma makes the fingers turn white, cold, and painful. The vessel needs to be repaired as soon as possible if blood flow has stopped. Sometimes nearby arteries can help to continue blood flow to the parts. In this case, the injury may not be an emergency or might not even require repair.
Aneurysms
A weakness in the artery wall that expands like a balloon. A soft, painless swelling may be noticed over the artery. A clot inside the artery can block the blood flow or may scatter smaller clots out to the fingertips. Other symptoms include pain, numbness, color changes, or gangrene (death) of the fingertips. Treatment may include surgery to reconstruct the artery or tie it off, depending on the circumstances.
Vascular Malformations
Tangled veins or arteries can be present at birth, but might not be noticed until they begin to expand. Some of these malformations might include abnormal connections between veins and arteries. Symptoms can include swelling, pain, warmth, increased growth of a part, and bleeding. Treatment choices include garments or wraps to apply pressure, clotting the vessels to try to shrink them, or removing part or all of the abnormal vessels with surgery.
Raynaud’s Phenomenon
A disease where finger arteries narrow more than normal when they are in cold temperatures. The fingers turn white and painful and then blue. Recovery of blood flow turns the fingers pink or red. Treatment includes avoiding the conditions that trigger the reaction, using protective clothing such as mittens or gloves, taking medications that increase blood flow to the fingers, and surgery. Wounds or ulcers on the fingers can heal poorly due to the low blood flow. Surgery to lessen the vessel narrowing or replace blocked parts of vessels can be considered if pain cannot be controlled or wounds do not heal.