Answer
The patient seems to be suffering from secondary Raynaud's disease, or Raynaud's Phenomenon. The cause of Raynaud's disease is not known for certain but it is associated with some conditions such as scleroderma, lupus erythematosus, and carpal tunnel syndrome.
The patient was told to stop smoking because nicotine from tobacco is one of the factors that triggers an episode of Raynaud's signs and symptoms.
Work Step by Step
The patient is suffering from Raynaud's disease. The pain and the changes in color of her cigarette fingers--pale to blueish (cyanotic) is due to the changes in blood supply to her extremities as her small arteries and arterioles constrict. The changes in degree of constriction is secondary to changes in sympathetic stimulation. Nicotine from the cigarettes is a sympathomimetic drug. When it is absorbed (transdermally in this case), it increases sympathetic stimulation which increases the constriction of the small arteries. This starves the relevant area, temporarily, of a constant blood supply; as the oxygenated blood leaves, the red color is lost and the pale color color of skin is prominent. The blueish color is the color of deoxygenated blood. When circulation is restored the first blood to pass through is deoxygenated blood from adjacent regions; this is the cause of the cyanotic bluish appearance. However, as the blood vessels dilate and normal blood circulation is restored the area may appear reddish or erythematous.
Smoking does not cause Raynaud's disease. Nevertheless, it is a precipitating factor of episodes of the signs and symptoms.
Other triggers are cold weather, alcohol. caffeine, and emotional stress.
The disease is diagnosed by x-rays and by having supected suffers to pace their hands in water cold water(10-15 deg, C). . If a patient has Raynauds the water challenge will precipitate the signs and symptoms.
The disease may be mild and easily dealt with if the patient keeps war. However if thedisese is not treated successfully it can lead to ulceration and gangrene in the feet hands and digits which may require amputations. Several drugs including vasodilators and alpha and Beta adrenergic blockers have been used in the treatment of Raynaud's disease. In severe cases, however, it is necessary to sever the pre-ganglionic sympathetic fibers (or destroying the relevant sympathetic ganglia) serving the area -- then the involved vessels dilate and the blood supply is restored.
