Raynaud's Phenomenon

What is Raynaud's phenomenon?

Raynaud's (say "ray-NOHZ") phenomenon is a condition in which blood flow to the surface tissue of the hands and feet is temporarily decreased, usually as an overresponse to cold temperatures. There are two kinds of Raynaud's phenomenon. Primary Raynaud's, also known as Raynaud's disease, occurs by itself and is the most common form. Secondary Raynaud's, also called Raynaud's syndrome, usually occurs as part of another disease and usually begins after age 35.

Raynaud's phenomenon is common but often goes unreported. For most people with the condition, Raynaud's is more of a nuisance than a disability.

What causes Raynaud's phenomenon?

Primary Raynaud's has no known cause. Secondary Raynaud's may develop as a result of another disease such as lupus, scleroderma, rheumatoid arthritis, or atherosclerosis. Other causes of secondary Raynaud's include taking certain medications, using vibrating power tools for several years, smoking, or having frostbite.

Exposure to cold is the most common trigger of an attack of Raynaud's phenomenon. In cold conditions, the body normally conserves heat by narrowing (constricting) blood vessels to the skin and opening (dilating) blood vessels to warm the internal parts of the body. During an attack of Raynaud's phenomenon, the body overreacts and severely restricts the flow of blood through small vessels to the skin. Emotional stress or certain medications can also trigger an attack. An attack of Raynaud's phenomenon usually lasts only a few minutes, but in some cases it may last over an hour, especially if the surrounding temperature remains low.

What are the symptoms?

During an attack of Raynaud's, the small blood vessels (capillaries) that supply blood to the skin become narrow (constrict), limiting blood flow to the hands and feet or, less commonly, the nose or ears. This often causes fingers or toes to feel cold and numb and then turn white. As blood flow returns and the fingers warm, they may turn blue, then red, and begin to throb and become painful.

How is Raynaud's phenomenon diagnosed?

Raynaud's phenomenon is diagnosed through a medical history and physical examination. There are no simple tests that can be used to diagnose the condition, so your health professional will rely on your description of your symptoms. Blood tests or other tests may be used to rule out other conditions that may be causing your symptoms.

How is it treated?

You may be able to prevent or relieve symptoms and limit attacks by avoiding the triggers of Raynaud's. Keep your body warm at all times. If you feel cold, your body will naturally redirect blood from your hands and feet to the central part of your body. If you can't keep the surrounding temperature above 68°F (20°C) to 70°F (21.1°C), wear extra layers of clothing to remain warm. Also, reduce anxiety, quit smoking, and avoid medications or other substances that trigger attacks, such as caffeine, cold medications that contain pseudoephedrine, and beta-blocker medications. If necessary, medication, such as a calcium channel blocker, may be prescribed to increase blood flow to the hands and feet and to relieve symptoms.

To keep hands and feet warm, wear mittens or gloves when it is cold outside, use potholders or oven mitts when getting something from the refrigerator or freezer, and wear wool or synthetic socks rather than pure cotton socks. Running warm water over your hands will often increase blood flow to them. Swinging your arms in a circle at the sides of your body ("windmilling") can temporarily increase blood flow into your fingers.

Frequently Asked Questions

Areas affected by Raynaud's phenomenon may:

• Feel cold or numb, as if they have fallen asleep.
• Turn white and then, as warming begins, change to blue and red or change directly from white to red.
• Turn blue, then red with warming. As colors develop, the affected areas may throb, ache, tingle, or feel cold or numb.

The hands, feet, nose, and ears can be affected by Raynaud's phenomenon. Raynaud's may affect one finger or several. Even nipples may be affected. In one series of cases, mothers with Raynaud's experienced nipple pain during breast-feeding.¹

Because an attack of Raynaud's phenomenon ends quickly, your health professional most often will determine whether you have Raynaud's phenomenon by your description of your symptoms. Your health professional will review your medical history, perform a physical examination, and do blood tests or other tests to rule out a secondary cause of Raynaud's phenomenon. If possible, you may want to take a color photograph of your hands when you are having symptoms to bring to your appointment.

A rheumatologist or dermatologist may examine the small blood vessels (capillaries) at the base of your fingernails using a small magnifying lens. Known as "capillaroscopy," this simple examination may help distinguish between primary Raynaud's and secondary Raynaud's that is part of a connective tissue disease such as lupus, scleroderma, or rheumatoid arthritis.

There is no cure for primary Raynaud's phenomenon, although the condition often can be effectively controlled. You may be able to limit or lessen the severity of attacks by keeping warm; managing emotional stress; and avoiding medications or other substances that affect blood flow, such as nicotine, caffeine, or cold medications that contain pseudoephedrine. Avoiding beta-blockers, which are often used to treat high blood pressure and fast or irregular heart rates, is also advised. Beta-blocker medications slow the heart rate and decrease how forcefully the heart contracts, causing even less blood to flow through your capillaries and making symptoms of Raynaud's worse.

If Raynaud's phenomenon can't be effectively controlled with home treatment and it interferes with daily activities, your health professional may prescribe medications. Medications such as calcium channel blockers (including nifedipine), sildenafil, angiotensin II receptor antagonists (such as losartan), vasodilators (such as nitroglycerin and hydralazine), which are used to treat high blood pressure, and selective serotonin reuptake inhibitors (such as fluoxetine) may help increase blood flow to your hands and feet and relieve symptoms.

Some alternative treatments have shown promise in treating Raynaud's phenomenon. Ginkgo biloba was shown in one study to reduce the number of Raynaud's attacks.² Certain behavioral therapies have also shown positive results. Biofeedback training or autogenic training, in which a person attempts to control blood flow and skin temperature, may help in treating Raynaud's phenomenon.

If the condition is related to an underlying disease, a drug, or a specific activity (secondary Raynaud's), treating the underlying disease or stopping the drug or activity may also decrease the symptoms of Raynaud's phenomenon.

Symptoms of Raynaud's phenomenon can often be relieved by home treatment.

To prevent or relieve symptoms of Raynaud's phenomenon that affect your hands or feet:

• Wear mittens or gloves anytime it is cool outside. Mittens are warmer than gloves because they keep your fingers together. Gloves underneath mittens will keep your hands warmer than gloves alone.
• Wear mittens or gloves or use pot holders or oven mitts when getting something from the freezer or refrigerator.
• Drink hot liquids. This helps maintain your internal body temperature.
• When drinking from a cold container such as a can or bottle, use an insulated cover.
• Warm your hands by running warm water over them or rubbing them together. This often will increase blood flow to your hands, relieving an attack of Raynaud's phenomenon. Be careful not to burn your hands under water that is too hot.
• Wear wool, synthetic, or cotton-blend socks rather than pure cotton socks. They keep your feet drier and warmer by pulling moisture away from your skin.
• Use foot powder to help absorb moisture from your feet. When your feet are damp, they are more easily chilled.
• Swing your arms rapidly in a circle at the sides of your body ("windmilling"), which can temporarily increase blood flow into your fingers.

To keep your whole body warm:

• Wear layers of warm clothing. The inner layer should be made of a material such as polypropylene that pulls moisture away from your body.
• Wear a hat. You lose more body heat from your head than from any other part of your body.
• Do not wear clothing that is too tight. Tight clothing can decrease or cut off circulation.
• Try to stay dry. Choose waterproof, breathable jackets and boots. Being wet makes you more likely to become chilled.
• Maintain even temperatures between rooms.

In general:

• Quit smoking, and avoid caffeine (in coffee, some soft drinks, and nonherbal teas). Nicotine and caffeine can cause blood vessels to become narrower (constrict). These drugs may trigger an attack of Raynaud's phenomenon or increase the severity of an attack.
• Avoid taking certain medications that may cause or aggravate Raynaud's phenomenon, such as drugs that affect blood flow, including cold medications that contain pseudoephedrine, some heart and blood medications, and migraine headache medications. Talk to your health professional about other steps you can take to reduce the effect of Raynaud's phenomenon while still taking these medications.
• Drink plenty of liquids to prevent dehydration, which can lower the amount of blood moving through the blood vessels and help bring on an attack of Raynaud's phenomenon or make an attack more severe.
• Eat a hot meal before going outside. Eating raises your body temperature and helps keep you warm.

Organizations

• Coronary Artery Disease
• Hepatitis B
• Lupus (Systemic Lupus Erythematosus)
• Rheumatoid Arthritis
• Sjögren's Syndrome

Citations

1. Anderson JE, et al. (2004). Raynaud's phenomenon of the nipple: A treatable cause of painful breastfeeding. Pediatrics, 113(4): e360–e364.

2. Muir AH, et al. (2002). The use of Gingko biloba in Raynaud's disease: A double-blind placebo-controlled trial. Vascular Medicine, 7(4): 265–267.

Other Works Consulted

• Cutolo M, et al. (2003). Raynaud's phenomenon and the role of capillaroscopy. Arthritis and Rheumatism, 48(11): 3023–3030.

• Pope J (2005). Raynaud's phenomenon (primary). Clinical Evidence (13): 1546–1554.

• Raynaud's Treatment Study Investigators (2000). Comparison of sustained-release nifedipine and temperature biofeedback for treatment of primary Raynaud phenomenon: Results from a randomized clinical trial with 1-year follow-up. Archives of Internal Medicine, 160(8): 1101–1107.

• Seibold JR (2005). Scleroderma. In ED Harris Jr et al., eds., Kelley's Textbook of Rheumatology, 7th ed., vol. 2, pp. 1279–1308. Philadelphia: Elsevier Saunders.

• Wigley FM (2002). Raynaud's phenomenon. New England Journal of Medicine, 347(13): 1001–1008.