Raynaud's Phenomenon

Topic Overview

What is Raynaud's phenomenon?

Raynaud’s (say “ray-NOHZ”) phenomenon is a problem with blood flow. Your body doesn't send enough blood to your hands and feet, so they feel very cold and numb. In most cases, this lasts for a short time when your body overreacts to cold temperatures.

There are two kinds of Raynaud’s phenomenon. Primary Raynaud’s is also known as Raynaud’s disease. It occurs on its own and is the most common form. Secondary Raynaud’s is also called Raynaud’s syndrome. It most often forms as part of another disease. It almost always begins after age 35.

Raynaud’s is common, but often people don't talk to a doctor about it. For most people, it is more of a nuisance than a disability.

What causes Raynaud's phenomenon?

Primary Raynaud’s has no known cause. Secondary Raynaud’s may be a symptom of another disease such as lupus, scleroderma, rheumatoid arthritis, or atherosclerosis. Taking certain medicines, using vibrating power tools for several years, smoking, or having frostbite may also cause Raynaud’s.

Certain things, such as stress and taking certain medicines, can trigger an attack. But the most common trigger is exposure to cold. In the cold, it’s normal for the body to narrow the small blood vessels to the skin and to open the blood vessels to the inside parts of the body to keep the body warm. But with Raynaud’s, the body overreacts and restricts blood flow through the small vessels to the skin more than necessary.

What are the symptoms?

During an attack of Raynaud’s, the body limits blood flow to the hands and feet. This makes the fingers or toes feel cold and numb and then turn white or blue. As blood flow returns and the fingers or toes warm, they may turn red and begin to throb and feel painful. In rare cases, Raynaud’s affects the nose or ears.

An attack most often lasts only a few minutes. But in some cases it may last more than an hour.

How is Raynaud's phenomenon diagnosed?

To diagnose Raynaud’s, your doctor will ask you questions about your symptoms and past health. He or she will also do a physical exam. Since Raynaud’s attacks are so sudden and brief, your doctor probably won't get to see you have an attack. So your doctor will want you to describe what happens to you during an attack.

There are no simple tests that your doctor can use to see if you have Raynaud’s. You may have a blood test or other tests to rule out certain diseases that may be causing your symptoms.

How is it treated?

If you have secondary Raynaud’s that is caused by another disease, your doctor can treat that disease. This may relieve your symptoms.

There is no cure for primary Raynaud’s, but you may be able to control it by avoiding the things that trigger it. These triggers include cold temperatures, stress, smoking, caffeine, cold medicines with pseudoephedrine, and beta-blockers. But don't stop taking prescribed medicines unless you talk to your doctor first.

You may be able to prevent Raynaud’s attacks with these home treatment tips:

• Remember to keep your body warm at all times.
• Wear mittens or gloves when it is cold outside.
• Use potholders or oven mitts when you get something from the refrigerator or freezer.
• Keep your feet warm by wearing wool or synthetic socks rather than pure cotton socks.
• Try running warm water over your hands. It can increase blood flow to them.

If you can't control your symptoms with home treatment, your doctor may give you a medicine called a calcium channel blocker. This may increase blood flow to your hands and feet and relieve symptoms.

Frequently Asked Questions

Symptoms

Areas affected by Raynaud's phenomenon may:

• Feel cold or numb, as if they have fallen asleep.
• Turn white or blue.
• 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

Exams and Tests

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.

Treatment Overview

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 medicines or other substances that affect blood flow, such as nicotine, caffeine, or cold medicines 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 medicines 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. Examples of beta-blockers are atenolol, inderal, and metoprolol. Do not stop taking medicines your doctor has prescribed, such as beta-blockers, without talking with your doctor.

If Raynaud's phenomenon can't be effectively controlled with home treatment and it interferes with daily activities, your health professional may prescribe medicines. Medicines 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.

Home Treatment

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 medicines that may cause or aggravate Raynaud's phenomenon, such as drugs that affect blood flow, including cold medicines that contain pseudoephedrine; some heart and blood medicines; and migraine headache medicines. Do not stop taking medicines your doctor has prescribed, such as beta-blockers, without talking with your doctor. Talk to your health professional about other steps you can take to reduce the effect of Raynaud's phenomenon while still taking these medicines.
• 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.
• Try eating a hot meal before going outside. Although there is no proof that this will help, some people believe that eating raises your body temperature and helps keep you warm.

Other Places To Get Help

Organizations

Related Information

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

References

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 (2007). Raynaud's phenomenon (primary), search date October 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
• 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.

Credits