Raynaud’s phenomenon

Raynaud’s disease, Raynaud syndrome

When your fingers or toes suddenly turn white or blue in response to cold or stress, you may be experiencing a condition that affects your blood vessels and circulation, causing temporary but sometimes painful episodes that can be managed with the right approach.

Table of contents

• What is Raynaud’s phenomenon?
• Two main types of Raynaud’s
• Who is affected by Raynaud’s phenomenon?
• Signs and symptoms
• Common triggers
• What causes Raynaud’s phenomenon?
• How is Raynaud’s diagnosed?
• Treatment options
• Lifestyle changes and self-care
• Living with Raynaud’s phenomenon

What is Raynaud’s phenomenon?

Raynaud’s phenomenon is a condition that causes certain areas of your body, most commonly your fingers and toes, to feel numb and cold in response to cold temperatures or stress.^[1] The condition affects your blood vessels, specifically the small vessels that supply blood to your skin.^[2]

When you have Raynaud’s phenomenon, these small blood vessels narrow much more than they should. This narrowing is called vasospasm (a tightening of the blood vessels), which limits blood flow to the affected areas.^[1] During an attack, the arterioles (tiny arteries) and capillaries (the smallest blood vessels) in your fingers and toes tighten more than they should, causing your skin to turn white and then blue because your blood lacks oxygen.^[2]

The condition was first described by Maurice Raynaud in 1862 and later studied by Sir Thomas Lewis in 1930.^[5] While Raynaud’s most commonly affects the fingers and toes, it can sometimes also affect your ears, nose, lips, or nipples.^[1]

Two main types of Raynaud’s

There are two types of Raynaud’s phenomenon: primary and secondary.^[4]

Primary Raynaud’s phenomenon (also called Raynaud’s disease) is the more common type. Its cause is unknown, and it is not linked with any other disease or condition.^[2] This form is usually mild, causing skin color changes, numbness, and a pins and needles sensation. It doesn’t cause skin ulcers or tissue death.^[2] For most people with primary Raynaud’s, the condition isn’t disabling, but it can affect quality of life.^[1]

Secondary Raynaud’s phenomenon (also called Raynaud’s syndrome when it occurs due to another condition) is less common and is caused by an underlying disease, condition, medication, or lifestyle factor.^[2] It is most commonly associated with connective tissue disorders such as scleroderma, systemic lupus erythematosus, Sjogren syndrome, and rheumatoid arthritis.^[5] Secondary Raynaud’s may be mild or more severe and can cause skin ulcers or, rarely, tissue death called gangrene (death of body tissue due to lack of blood supply).^[2]

In primary Raynaud’s, the blood vessel abnormalities are mainly functional, meaning they work improperly but have no structural damage. However, in secondary Raynaud’s, both functional and structural problems occur in blood vessels. This explains why tissue damage frequently occurs in secondary Raynaud’s but not in primary Raynaud’s.^[12]

Who is affected by Raynaud’s phenomenon?

Raynaud phenomenon occurs in about 4% of people overall.^[8] Women are more likely than men to have the condition.^[1] In fact, women are nine times more likely to have Raynaud’s than men.^[16]

Primary Raynaud’s usually affects people under age 30, often starting in the teenage years.^[2] It seems to be more common in people who live in colder climates.^[1] People who have a family history of Raynaud’s disease are also more likely to develop it.^[2]

Secondary Raynaud’s typically affects older people, often those over 30 years old.^[8] Certain diseases increase the risk of developing secondary Raynaud’s, including lupus, scleroderma, Sjogren’s syndrome, and rheumatoid arthritis.^[3] Other causes include certain medicines (such as those treating high blood pressure, migraines, and attention deficit hyperactivity disorder), work-related exposures such as repeated use of vibrating machinery like jackhammers, or exposure to certain chemicals.^[5]

Signs and symptoms

Symptoms of Raynaud’s phenomenon include cold fingers or toes, and areas of skin that change color.^[1] During an attack, your fingers and toes may turn white, then blue, and finally red. Depending on your skin color, these color changes may be harder or easier to see.^[1]

The classic pattern is a three-phase color change. One or multiple fingers or toes can initially turn white due to decreased blood flow. They may then turn blue due to lack of oxygen in the tissues. Upon rewarming, there is a sudden rush of blood to the affected areas, causing the fingers or toes to become red in color. This is known as a triphasic color change, which is typical for Raynaud’s.^[3]

Other symptoms can include pain, numbness, a numb or prickly feeling, stinging pain upon warming, and pins and needles.^[1] The affected areas may feel cold and numb until blood flow improves, usually after warming up.^[1] As your blood vessels relax and open up again, your skin may look red or feel tingly.^[2]

An attack may last a few minutes or a few hours.^[4] Symptoms can last for seconds to many minutes. If symptoms last for hours or are persistent despite attempts at rewarming, this can suggest more serious disease.^[3]

Patients with severe Raynaud’s can develop skin ulcers (open sores) on their fingertips or toes due to tissue death resulting from lack of blood flow.^[3] Some people also find that their ears, nose, lips, or nipples are affected.^[7]

Common triggers

Raynaud’s attacks are typically triggered by cold temperatures or emotional stress.^[8] Cold temperatures are a common trigger. Attacks most often happen when you get cold, for example, when you grab something cold from the freezer or go into an air-conditioned building on a warm day.^[4]

Emotional stress can also trigger symptoms in some people.^[6] When you’re cold, anxious, or stressed, your fingers and toes may change color.^[7]

What causes Raynaud’s phenomenon?

Researchers don’t know exactly why some people develop Raynaud’s phenomenon, but they do understand how the attacks happen.^[4] When you are exposed to cold, your body tries to slow the loss of heat and maintain its temperature. To do this, the blood vessels in the top layer of your skin narrow, which moves blood from those vessels near the surface to vessels deeper in the body. But when you have Raynaud’s phenomenon, the blood vessels in your hands and feet react to cold or stress by narrowing quickly and staying narrowed for a long time.^[4]

In response to cold temperatures, the body adapts by restricting blood flow to the skin as a way to regulate temperature and prevent further loss of body heat and sustain core body temperature. In Raynaud’s phenomenon, there is excessive narrowing of the digital arteries and blood vessels that supply the skin.^[5]

The exact cause of primary Raynaud’s is unknown and it is not linked with an underlying disease.^[2] Genetic and hormonal factors, particularly estrogen, are likely contributors.^[12]

Secondary Raynaud’s has various causes. The most common are connective tissue diseases such as scleroderma, systemic lupus erythematosus, Sjogren syndrome, and antiphospholipid syndrome.^[5] Other causes include certain drugs such as antimigraine medications, interferon alpha and beta, cyclosporine, and nonselective beta blockers.^[5] Occupations that result in exposure to vibration from vibrating machinery (known as hand-arm vibration syndrome), exposure to polyvinyl chloride, cold injury from work, or ammunition work are other occupational-associated causes.^[5]

In people older than 60 years, obstructive vascular disease is a frequent cause of Raynaud’s phenomenon. These include conditions like thromboangiitis obliterans, microemboli, diabetic angiopathy, or atherosclerosis.^[5] Other causes include fibromyalgia, polycythemia, arteriovenous fistula, myalgic encephalitis, or malignancy.^[5]

How is Raynaud’s diagnosed?

There is no specific test to diagnose Raynaud’s phenomenon.^[4] Diagnosis is typically based on the symptoms.^[8] To find out if you have it, your healthcare professional will take your medical history, ask about your symptoms, and do a physical exam.^[4]

A test called nailfold capillaroscopy can help tell the difference between primary and secondary Raynaud’s. During this test, the professional uses a microscope or magnifier to look for anything unusual on the skin at the base of a fingernail, such as swelling of the blood vessels.^[9] Nailfold capillaroscopy remains the gold standard for distinguishing between primary and secondary Raynaud’s.^[12]

Blood tests can help find out whether another condition, such as an autoimmune condition or a connective tissue disease, is causing Raynaud’s.^[9] Blood tests for Raynaud’s might include an antinuclear antibodies test (also called an ANA test). A positive test result often means that your immune system is mistakenly attacking body tissue, which is called an autoimmune reaction. Such immune system activity is common in people who have connective tissue diseases or other autoimmune disorders.^[9]

Another blood test is the erythrocyte sedimentation rate. This test shows the rate at which red blood cells fall to the bottom of a tube. A faster than typical rate might signal an inflammatory or autoimmune disease.^[9] No one blood test can diagnose Raynaud’s. Other tests, such as those that rule out diseases of the blood vessels, can help find a condition that can be related to Raynaud’s.^[9]

Your healthcare provider may order tests to rule out other medical problems that can cause the same symptoms and to help decide which type of Raynaud’s phenomenon you have.^[4] If there are signs of acute tissue injury, vascular imaging, particularly before surgery, is crucial to rule out other conditions that block blood vessels.^[12]

Treatment options

Treatment of Raynaud’s depends on how severe it is and whether you have other health conditions.^[1] The goals of treatment are to reduce the number of attacks and how bad they are, prevent tissue damage from happening, and treat any underlying disease or condition.^[9]

For many people, especially those with the primary type, the symptoms are mild.^[4] Primary Raynaud’s syndrome isn’t serious and doesn’t damage your blood vessels. It may disrupt some of your daily activities, but it’s not dangerous.^[2]

Dressing for the cold in layers and wearing gloves or heavy socks usually can help mild symptoms of Raynaud’s.^[9] The primary treatment is avoiding the cold.^[8] Other measures include stopping the use of nicotine or stimulants.^[8]

When lifestyle changes are not enough, medicines can treat more serious symptoms. Depending on the cause of symptoms, medicines might help.^[9] Medications for treatment of cases that do not improve include calcium channel blockers and iloprost.^[8]

Calcium channel blockers are medicines that help widen blood vessels. Medications such as amlodipine, nifedipine, and felodipine are commonly used to increase blood flow to the fingers and toes.^[3] Some people need to take this medicine every day, while others only use it to prevent Raynaud’s, for example, during cold weather.^[7]

For patients with more severe symptoms or who have developed complications such as ulcers, other medications can be used including sildenafil (a phosphodiesterase-5 inhibitor) or prostacyclins (prostaglandin analogs).^[3] Bosentan, an endothelin-1 receptor antagonist, has shown effectiveness in treating and preventing digital ulcers, especially in patients with multiple ulcers.^[12]

For severe cases, botulinum toxin injections or sympathectomy surgery can be used to control Raynaud’s symptoms. However, botulinum toxin injections require repeated administration, and sympathectomy’s long-term effectiveness is uncertain.^[12] Fat grafting is a promising surgical therapy for promoting healing and preventing tissue injury.^[12]

If you have Raynaud’s and your symptoms are very bad or getting worse, a healthcare provider may prescribe a medicine to help improve your circulation.^[7] A healthcare provider may arrange tests if they think Raynaud’s could be a sign of a more serious condition, such as rheumatoid arthritis or lupus.^[7]

Lifestyle changes and self-care

Raynaud’s can be managed with both lifestyle changes and medications.^[3] There are many things you can do to help prevent Raynaud’s episodes or ease symptoms.

To keep your body warm, wear warm, protective clothing like socks, boots, mittens, or gloves in the fall and winter.^[3] Wear mittens or gloves when it is cold outside. Mittens are warmer than gloves because they keep your fingers together. Gloves underneath mittens will keep your hands warmer than gloves alone.^[23] You can also use pot holders or oven mitts when getting something from the freezer or refrigerator.^[23] You can slip chemical hand warmers into your mittens or gloves when you do outside activities.^[23]

Wear a hat, as keeping your whole body warm is important.^[23] In the summer months, avoid keeping the temperature of the air conditioning too low.^[3] Try to avoid sudden changes in temperature.^[7] Wear layers of warm clothing and choose waterproof, breathable jackets and boots. Being wet makes you more likely to become chilled.^[23]

Do not smoke. Improve your circulation by quitting smoking.^[7] Nicotine makes blood vessels constrict, which can bring on an attack. If you need help quitting, talk to your doctor about stop-smoking programs and medicines.^[23]

Do not have too much caffeine, found in tea, coffee, cola, and chocolate, as it may trigger the symptoms of Raynaud’s.^[7] Some medicines can make Raynaud’s worse. Talk with your doctor about all of the medicines you take, even over-the-counter medicines, to make sure they aren’t triggering an attack.^[23]

Exercise regularly, as this helps improve circulation.^[7] Try breathing exercises or yoga to help you relax.^[7] Stress reduction is also recommended to help decrease Raynaud’s attacks.^[3] Try to stay calm when you are under stress, as anxiety can make your blood vessels constrict and lead to a Raynaud’s attack.^[23]

Eat a healthy, balanced diet.^[7] Eat a hot meal and drink a warm liquid before going outside, as they may help raise your body temperature.^[23]

Living with Raynaud’s phenomenon

If symptoms occur, there are steps you can take to rewarm your body. Run warm water over your hands or feet to increase blood flow. Use another part of your body, such as your forearm, to make sure the water is not too hot; you could burn your hands or feet and not feel it because they are numb.^[23] Run fingers or toes under warm (not hot) water.^[3]

Place hands under the armpits to warm them up.^[3] Wiggle your fingers and toes, or move your arms and legs around to get blood flowing.^[23] Swing your arms in a circle at the sides of your body (windmilling) to increase blood flow.^[23] Massage the hands and feet.^[3]

You should see a healthcare provider if you have symptoms of Raynaud’s that are very bad or getting worse, Raynaud’s is affecting your daily life, your symptoms are only on one side of your body, you also have joint pain, skin rashes or muscle weakness, you’re over 30 years old and get symptoms of Raynaud’s for the first time, or your child is under 12 years old and has symptoms of Raynaud’s.^[7]

Call your doctor or seek immediate medical care if you have severe pain in your hands or feet, normal color does not return to your hands or feet, or your hands or feet do not warm up even after home care.^[23]

As with any ailment, there is little evidence that alternative medicine is helpful.^[8] However, if another condition causes your Raynaud’s, make sure to follow your treatment for that condition.^[23] If your doctor prescribes medicine to help Raynaud’s, take it exactly as prescribed.^[23]

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems.^[23] Watch closely for changes in your health, and be sure to contact your doctor if you have any problems.^[23]