Raynaud Phenomenon
Color changes and numbness in fingers and toes triggered by cold or stress
Quick Facts
- Type: Blood vessel (vascular) condition
- Main triggers: Cold exposure, emotional stress
- Classic signs: White, then blue, then red fingers or toes
- Types: Primary (no underlying disease) and secondary
Overview
Raynaud phenomenon is an exaggerated narrowing of the small blood vessels that supply the skin, usually in the fingers and toes. When triggered by cold or emotional stress, these vessels constrict sharply and briefly cut off normal blood flow, so the affected areas turn pale or white, often followed by blue and then red as blood returns.
There are two forms. Primary Raynaud occurs on its own without an underlying disease and is usually mild. Secondary Raynaud is linked to another condition, often an autoimmune disease, and tends to be more serious. Most people with Raynaud manage well by avoiding triggers and keeping warm, though some need medication.
Symptoms
An episode (or "attack") typically follows a recognizable pattern, though not everyone shows all three color changes:
- White: The skin turns pale as blood flow drops sharply.
- Blue: The area becomes bluish and feels cold and numb.
- Red: As blood flow returns, the skin flushes red and may throb, tingle, or sting.
Attacks most often affect the fingers and toes but can involve the nose, ears, lips, or nipples. Episodes may last minutes to over an hour. In severe secondary Raynaud, prolonged poor blood flow can lead to skin sores or ulcers, which need medical attention.
Causes
Raynaud occurs when blood vessels overreact to cold or stress and constrict more than normal. The reason for this overreaction is not fully understood in primary Raynaud. In secondary Raynaud, an underlying condition damages or affects the blood vessels. Common triggers and associations include:
- Cold exposure: Cold air, handling cold objects, or moving into air conditioning.
- Emotional stress: Strong emotion can set off the vessel response.
- Connective tissue and autoimmune diseases: Such as scleroderma and lupus, which are common causes of secondary Raynaud.
- Repetitive trauma or vibration: From tools or repeated motions.
- Certain medications: Some blood pressure, migraine, and cold remedies can narrow vessels.
Risk Factors
- Female sex and younger age (primary Raynaud often begins in the teens to 30s)
- Living in a cold climate
- A family history of Raynaud
- An autoimmune or connective tissue disease such as scleroderma or lupus
- Smoking, which narrows blood vessels
- Jobs or hobbies involving vibration or repetitive hand use
Diagnosis
Doctors usually diagnose Raynaud from the description of color changes triggered by cold or stress. Further testing helps separate primary from secondary disease:
- Nailfold capillaroscopy: Examining the tiny blood vessels at the base of the fingernails under magnification can suggest an underlying connective tissue disease.
- Blood tests: Tests such as antinuclear antibody (ANA) screening look for autoimmune conditions.
Identifying secondary Raynaud is important because it may be the first sign of another disease that needs its own treatment.
Treatment
For many people, simple measures to stay warm and avoid triggers control symptoms. When needed, treatment also includes:
- Lifestyle steps: Wearing gloves and warm layers, warming the hands and body, managing stress, and stopping smoking.
- Medications: Calcium channel blockers (such as nifedipine) relax and open blood vessels and are commonly used for frequent or severe attacks; other vessel-widening medicines may be added.
- Treating the underlying cause: In secondary Raynaud, managing the related disease and avoiding triggering drugs is key.
- Wound care: Skin sores from severe Raynaud need prompt medical treatment to prevent infection and tissue damage.
Prevention
- Dress warmly and protect the hands and feet, even for brief cold exposure
- Keep your whole body warm, not just the extremities
- Avoid sudden temperature changes and handling frozen items barehanded
- Manage stress with relaxation techniques
- Do not smoke and limit caffeine if it triggers attacks
- Ask your doctor before using vessel-narrowing medications or decongestants
When to See a Doctor
See a doctor if Raynaud attacks are frequent, severe, affect only one side of the body, or begin after age 40, as these may point to secondary Raynaud. Seek prompt care if you develop:
- Skin sores, ulcers, or non-healing wounds on the fingers or toes
- Signs of infection such as increasing pain, redness, swelling, or discharge
- An area that stays cold, numb, or discolored and does not recover
Frequently Asked Questions
What does a Raynaud attack look like?
During an attack, the fingers or toes typically turn white as blood flow drops, then blue as they become cold and numb, and finally red as blood returns and the area throbs or tingles. Attacks are usually triggered by cold or emotional stress and last minutes to over an hour.
Is Raynaud phenomenon dangerous?
Primary Raynaud is usually mild and not dangerous. Secondary Raynaud can be more serious because severely reduced blood flow may cause skin sores or ulcers, and it may signal an underlying disease. See a doctor if attacks are severe, one-sided, or cause wounds.
What is the difference between primary and secondary Raynaud?
Primary Raynaud occurs on its own without an underlying disease and is generally mild. Secondary Raynaud is associated with another condition, often an autoimmune disease like scleroderma or lupus, and tends to be more severe and to need closer follow-up.
How can I prevent Raynaud attacks?
Keeping warm is the most effective step: wear gloves and warm layers, protect your whole body from cold, and avoid sudden temperature changes. Not smoking, managing stress, and avoiding vessel-narrowing medications also help.
When should I worry about Raynaud?
See a doctor if attacks are frequent or severe, start after age 40, affect just one side, or if you develop sores or ulcers on your fingers or toes. These may indicate secondary Raynaud or a wound that needs prompt treatment.
References
- National Heart, Lung, and Blood Institute (NHLBI). Raynaud's.
- Mayo Clinic. Raynaud's disease — Symptoms and causes.
- MedlinePlus, U.S. National Library of Medicine. Raynaud's phenomenon.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).