Raynaud phenomenon

  • Definition
    • Raynaud phenomenon is a condition in which cold temperatures or strong emotions cause blood vessel spasms. This blocks blood flow to the fingers, toes, ears, and nose.

  • Alternative Names
    • Raynaud's phenomenon

  • Causes
    • Raynaud phenomenon is called "primary" when it is not linked to another disorder. It most often begins in women younger than age 30. Secondary Raynaud phenomenon is linked to other conditions and usually occurs in people who are over age 30.

      Common causes of secondary Raynaud phenomenon are:

  • Symptoms
    • Exposure to the cold or strong emotions bring on the changes.

      • First, the fingers, toes, ears, or nose become white, and then turn blue.
      • When blood flow returns, the area becomes red and then later returns to normal color.
      • The attacks may last from minutes to hours.

      People with primary Raynaud phenomenon have problems in the same fingers on both sides. Most people do not have much pain.

      People with secondary Raynaud phenomenon are more likely to have pain or tingling in the fingers. The pain is rarely severe. However, painful ulcers may form on the affected fingers if the attacks are very bad.

  • Exams and Tests
    • Your health care provider can often discover the condition causing Raynaud phenomenon by asking you questions and doing a physical exam.

      Tests that may be done to confirm the diagnosis include:

      • Examination of the blood vessels in the fingertips using a special lens called nailfold capillary microscopy
      • Vascular ultrasound
      • Blood tests to look for arthritic and autoimmune conditions that may cause Raynaud phenomenon
  • Treatment
    • Taking these steps may help control Raynaud phenomenon:

      • Keep the body warm. Avoid exposure to cold in any form. Wear mittens or gloves outdoors and when handling ice or frozen food. Avoid getting chilled, which may happen after any active recreational sport.
      • Stop smoking. Smoking causes blood vessels to narrow even more.
      • Avoid caffeine.
      • Avoid taking medicines that cause blood vessels to tighten or spasm.
      • Wear comfortable, roomy shoes and wool socks. When outside, always wear shoes.

      Your provider may prescribe medicines to relax the walls of the blood vessels. These include topical nitroglycerin cream that you rub on your skin, calcium channel blockers, sildenafil (Viagra), and ACE inhibitors.

      It is vital to treat the condition causing Raynaud phenomenon.

  • Outlook (Prognosis)
    • The outcome varies. It depends on the cause of the problem and how bad it is.

  • Possible Complications
    • Complications may include:

      • Gangrene or skin ulcers may occur if an artery becomes completely blocked. This problem is more likely in people who also have arthritis or autoimmune conditions.
      • Fingers may become thin and tapered with smooth shiny skin and nails that grow slowly. This is due to the poor blood flow to the areas.
  • When to Contact a Medical Professional
    • Call your provider if:

      • You have a history of Raynaud phenomenon and the affected body part (hand, foot, or other part) becomes infected or develops a sore.
      • Your fingers change color when they are cold.
      • Your fingers or toes turn black or the skin breaks.
      • You have a sore on the skin of your feet or hands which does not heal.
      • You have a fever, swollen or painful joints, or skin rashes.
  • References
    • Bakst R, Merola JF, Franks AG Jr, Sanchez M. Raynaud's phenomenon: pathogenesis and management. J Am Acad Dermatol. 2008;59(4):633-53. PMID: 18656283

      Herrick AL. Contemporary management of Raynaud's phenomenon and digital ischaemic complications. Curr Opin Rheumatol. 2011;23(6):555-61. PMID: 21885977

      James WD, Berger TG, Elston DM. Cutaneous vascular diseases. In: James WD, Berger TG, Elston DM, eds. Andrews' Diseases of the Skin. 12th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 35.

      Spencer-Green G. Outcomes in primary Raynaud phenomenon: a meta-analysis of the frequency, rates, and predictors of transition to secondary diseases. Arch Intern Med. 1998;158(6):595-600. PMID: 9521223

      Swanson KE, Bartholomew JR, Paulson R. Hypothenar hammer syndrome: a case and brief review. Vasc Med. 2012;17(2):108-15. PMID: 22169157