Raynaud's Phenomenon

What is Raynaud's phenomenon?

Raynaud's is a rare disorder of the blood vessels supplying the skin. During a Raynaud's attack, the blood vessels narrow, limiting blood circulation to affected areas. It makes parts of the body (usually fingers, toes, nose and ears) feel numb and cool in low temperatures or under stress.

Raynaud's can be classified into two types. When it occurs without another disease present, it is called Raynaud's disease (or primary Raynaud's). This is the most common type and typically affects both hands and both feet. Although it can affect men, it most often occurs in women between 15 and 40.

When it occurs as part of another disease, it is called Raynaud's phenomenon (or secondary Raynaud's). This type usually affects either both hands or both feet. Causes may include scleroderma, lupus, rheumatoid arthritis, Sjögren's syndrome, diseases of the arteries, carpal tunnel syndrome, smoking, chemical exposure, certain drugs or injury.


What causes Raynaud's phenomenon?

The exact cause of Raynaud’s is unknown. It is possible that some blood disorders may cause Raynaud’s by increasing the blood thickness. This may happen due to excess platelets or red blood cells. Or special receptors in the blood that control the narrowing of the blood vessels may be more sensitive.

Who is at risk for Raynaud's phenomenon?

Certain factors can increase your risk of developing the condition, such as:

  • Scleroderma. Raynaud's phenomenon occurs in about 90% of people who have scleroderma, a rare disease that leads to hardening and scarring of the skin.
  • Lupus. Between 30 and 40% of Americans with lupus (a disease that can affect many parts of the body, including the skin, joints, organs and blood vessels) develop Raynaud's.
  • Rheumatoid arthritis. Raynaud's often is the first sign of rheumatoid arthritis, an inflammatory condition causing pain and stiffness in the body's joints, often including the hands and feet.
  • Sjögren's syndrome. Raynaud's phenomenon can occur in people who have this rare disorder that often comes with scleroderma, lupus or rheumatoid arthritis.
  • Diseases of the arteries. Raynaud's phenomenon can occur with diseases that affect arteries, such as Buerger's disease, in which the blood vessels of the hands and feet become inflamed.
  • Carpal tunnel syndrome. The carpal tunnel is a narrow passage in your wrist that protects a major nerve to your hand. Carpal tunnel syndrome is a condition in which pressure is put on this nerve, producing numbness and pain in the affected hand.
  • Repetitive trauma. Raynaud's also can be caused by repetitive trauma that damages nerves serving blood vessels in the hands and feet. Some people who type or play the piano for long periods of time or vigorously may be susceptible to Raynaud's. Workers who use vibrating tools can develop Raynaud's phenomenon.
  • Smoking. Smoking constricts blood vessels and can cause Raynaud's.
  • Injuries. Injuries to the hands or feet from surgery or frostbite, for example, can lead to Raynaud's phenomenon.
  • Certain drugs. Some drugs, such as beta blockers (used to treat high blood pressure), ones for migraines that have ergotamine, estrogen replacement therapy, certain chemotherapy agents and drugs that cause blood vessels to narrow (such as some over-the-counter cold medications), have been linked to Raynaud's.
  • Chemical exposure. Some plastics industry workers who are exposed to vinyl chloride develop an illness like scleroderma. Raynaud's can be a part of that.
  • Other causes. Raynaud's has also been linked to an overactive thyroid gland (hyperthyroidism), a condition in which blood pressure rises in the blood vessels of the lungs (pulmonary hypertension) and, rarely, to certain cancers.

What are the symptoms of Raynaud's phenomenon?

Symptoms can occur a bit differently in each person. Common symptoms include:

  • Fingers that turn pale or white then blue when exposed to cold, or during stress or emotional upset, then red when the hands are warmed
  • Hands that may become swollen and painful when warmed
  • Sores on the finger pads develop, in severe cases
  • Gangrene in the fingers that causes infection or needs amputation, this is rare

How is Raynaud's phenomenon diagnosed?

The process starts with a medical history and a physical exam. Your healthcare provider may give you a cold challenge test. This is done to see the color changes in the hands and fingers. During the test, your hands are exposed to cold. Your healthcare provider may also look at the tiny blood vessels in your fingernails with a microscope. Adults who start to have Raynaud’s phenomenon after age 35 may be tested for an underlying disease. You may have blood tests to see if your condition is primary or secondary.

Your doctor may also do blood tests or other tests.

How is Raynaud's phenomenon treated?

Treatment will depend on your symptoms, your age, and your general health. It will also depend on how severe the condition is. There is no cure for Raynaud’s phenomenon, but it can be managed with proper treatment. Treatment may include:

  • Avoiding exposure to cold
  • Keeping warm with gloves, socks, scarf, and a hat
  • Stopping smoking
  • Wearing finger guards over fingers with sores
  • Avoiding trauma or vibrations to the hand (such as with vibrating tools)
  • Taking blood pressure medicines during the winter months to help reduce constriction of the blood vessels

Several other types of drugs may be helpful. To widen blood vessels and promote circulation, your doctor may prescribe:

  • Calcium channel blockers. These drugs relax and open up small blood vessels in the hands and feet. They decrease the frequency and severity of attacks in about two-thirds of the people who have Raynaud's.
  • Alpha blockers. Some people find relief with these drugs, which counteract norepinephrine, a hormone that shrinks blood vessels.
  • Vasodilators. Some doctors prescribe a vasodilator (a drug that relaxes blood vessels), such as nitroglycerine cream.

Talk with your healthcare providers about the risks, benefits, and possible side effects of all medicines.

What are the complications of Raynaud’s phenomenon?

In rare cases, sores on finger pads may occur. These sores may progress to gangrene. In rare cases, gangrene may lead to finger amputation.

Living with Raynaud’s phenomenon

For most people living with Raynaud’s, it is more of an inconvenience than a serious problem. Avoiding triggers, primarily cold, can reduce the spasms that lead to symptoms.

Dressing warmly outdoors can help prevent attacks. So can taking precautions indors — wear socks, and when taking food out of the refrigerator or freezer, wear, gloves, mittens or oven mitts.

If you are experiencing an attack of Raynaud's, the most important step is to warm your hands and feet or other affected areas of skin. The following can help you gently warm your fingers and toes:

  • Move to a warmer place
  • Place your hands under your armpits
  • Wiggle your fingers and toes
  • Make wide circles or windmills with your arms
  • Run warm (not hot) water over your fingers and toes

If there is an underlying cause, such as scleroderma or lupus, it may be more difficult to manage attacks. If you have secondary Raynaud’s, work with your healthcare provider to manage your underlying condition. This may decrease attacks of Raynaud’s.

When should I call my health care provider?

If your symptoms get worse or you have new symptoms, let your healthcare provider know.

Key points about Raynaud’s phenomenon

  • Raynaud’s phenomenon is a disorder that causes decreased blood flow to the fingers. In some cases, it also causes less blood flow to the ears, toes, nipples, knees, or nose.
  • Spasms of blood vessels happen in response to cold, stress, or emotional upset.
  • Secondary causes of Raynaud’s include lupus, scleroderma, and other diseases.
  • Symptoms of Raynaud’s include fingers that turn pale or white then blue when exposed to cold, or during stress or emotional upset. They then red when the hands are warmed.
  • Managing Raynaud’s includes avoiding cold, dressing warmly, and stopping smoking.
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