Raynaud Phenomenon (Raynaud's)

What happens during an attack

When exposed to cold or emotional stress, blood vessels in the skin normally narrow to conserve heat. In Raynaud phenomenon, this response is exaggerated. Small arteries in the fingers or toes clamp down so tightly that blood flow almost stops.

A typical attack:

1. White (pallor): the affected digits turn sharply white, often with a clear line, and feel cold and numb.
2. Blue (cyanosis): the remaining blood loses oxygen.
3. Red (rewarming): blood flows back, causing throbbing, tingling or burning.

Not everyone has all three colors. Attacks usually last minutes, sometimes longer. Toes, ears, nose, lips and nipples can also be affected.

Primary vs secondary Raynaud's

Raynaud's disease usually refers to the primary form. See Raynaud disease.

Causes of secondary Raynaud's

• connective tissue diseases: scleroderma (Raynaud's occurs in about 9 in 10 people with systemic sclerosis), lupus, Sjogren's disease, dermatomyositis, mixed connective tissue disease. See connective tissue disease.
• medicines: beta blockers, migraine drugs (ergotamines, triptans), ADHD stimulants, some chemotherapy, decongestants
• vibration exposure: using vibrating tools such as jackhammers and chainsaws causes vibration white finger
• artery disease and thoracic outlet syndrome
• carpal tunnel syndrome
• smoking, which narrows blood vessels
• hypothyroidism
• blood disorders that thicken the blood, such as cryoglobulinemia

Diagnosis

A doctor will ask about color changes, triggers, age at onset and other symptoms, and examine the hands, skin and pulses. Tests may include:

• nailfold capillaroscopy: a magnified look at the tiny vessels at the base of the fingernail; enlarged or missing loops suggest a connective tissue disease
• blood tests: ANA, specific antibodies, blood count, inflammatory markers and thyroid function
• vascular tests if a blocked artery is suspected

People with primary Raynaud's and normal tests rarely develop a connective tissue disease, but new symptoms should be reported.

Treatment

Prevent attacks

• keep the whole body warm, not just the hands: layers, hat, scarf
• wear warm gloves and socks; use hand and foot warmers
• warm up the car before driving in cold weather
• use insulated cups for cold drinks, and gloves when handling frozen food
• avoid sudden temperature changes, including air-conditioned rooms
• stop smoking
• reduce caffeine if it worsens symptoms
• manage stress
• review medicines with your doctor

During an attack

• move to a warm place
• run warm (not hot) water over fingers or toes
• wiggle fingers and toes, swing arms in circles to push blood to the hands
• place hands under your armpits

Medicines

For frequent or severe attacks:

• calcium channel blockers such as nifedipine or amlodipine (first-line)
• PDE5 inhibitors (sildenafil, tadalafil)
• topical nitrate creams
• losartan, fluoxetine in some cases
• IV prostacyclin (iloprost) for severe attacks and ulcers
• botulinum toxin injections for severe cases

Ulcer care

Digital ulcers need urgent medical care: wound care, infection treatment, stronger vasodilators, and sometimes surgery (sympathectomy) in severe secondary Raynaud's.

Outlook

Primary Raynaud's is a nuisance but does not damage tissue. Secondary Raynaud's needs treatment of the underlying condition and closer follow-up to prevent ulcers and tissue loss.

Frequently asked questions

What is Raynaud's phenomenon?

Raynaud's is a condition in which the small blood vessels of the fingers and toes overreact to cold or stress, narrowing so much that the digits turn white, then blue and red, often with numbness and throbbing.

What is the difference between Raynaud's disease and Raynaud's phenomenon?

Raynaud's disease usually means primary Raynaud's, which occurs on its own and is mild. Raynaud's phenomenon is often used as the umbrella term, and secondary Raynaud's is linked to another condition such as scleroderma or lupus.

Is Raynaud's serious?

Primary Raynaud's is usually harmless. Secondary Raynaud's can be more severe and cause painful ulcers or tissue damage, and it may signal an underlying disease, so it needs medical evaluation.

How do you stop a Raynaud's attack?

Get to a warm place, run warm water over the affected fingers or toes, move and swing your arms to boost blood flow, and tuck your hands into your armpits. Attacks usually end within 15 to 20 minutes.

Can Raynaud's be cured?

Primary Raynaud's has no cure, but most people control it well by keeping warm and avoiding triggers, and some improve over time. Secondary Raynaud's improves when the underlying cause is treated, and medicines reduce attacks.