Raynaud’s Phenomenon: What to Know
Medically reviewed by Marla Anderson, MDMedically reviewed by Marla Anderson, MD
Raynaud’s phenomenon is a condition that causes blood vessels in the hands and sometimes the feet to constrict, limiting blood flow to the fingers and toes. This reduced blood flow causes numbness and color changes in the fingers and toes and can be painful.
Cold and stress are typical causes of a Raynaud’s attack or episode, which can last for minutes to hours. Sometimes called Raynaud’s syndrome, the disease can occur on its own or be linked to various underlying conditions, such as lupus or scleroderma.
This article describes the types of Raynaud’s phenomenon, symptoms, diagnosis, treatment, and ways to manage the phenomenon.
Reproduced with permission from © DermNet dermnetnz.org 2023.
Types of Raynaud’s Phenomenon
The two types of Raynaud’s phenomenon are primary and secondary. Primary Raynaud’s is idiopathic, meaning it occurs spontaneously with no known cause. This is known as Raynaud’s disease.
Secondary Raynaud’s occurs due to an underlying disease. It is known as Raynaud’s syndrome.
Primary Raynaud’s Disease
Primary Raynaud’s disease often occurs spontaneously with no known cause. It is typically benign (not harmful) and does not cause lasting damage.
Attacks of Raynaud’s disease may last an hour but can last longer. They usually occur symmetrically (both hands or both feet) and episodically. While bothersome, the attacks aren’t painful. People with Raynaud’s disease normally have a negative antinuclear antibody (ANA) test, and their inflammatory markers (tests that indicate inflammation) are normal.
Secondary Raynaud’s Syndrome
Secondary Raynaud’s is a manifestation of an underlying condition. In some cases, Raynaud’s may be the first indication that something else is going on in the body.
Raynaud’s is often the presenting, or first, symptom for connective tissue diseases (autoimmune disorders in which a malfunctioning immune system causes inflammation of collagen and elastin fibers) like lupus and scleroderma.
While primary Raynaud’s is typically benign, secondary Raynaud’s syndrome can lead to complications such as gangrene, which leads to tissue death, if the underlying condition is not addressed.
People with secondary Raynaud’s have more frequent attacks and will often describe them as being painful. They occur asymmetrically (only on one side of the body) and can leave lasting scars or pits in the skin.
Conditions associated with Raynaud’s syndrome include:
Lupus (a chronic autoimmune disease that causes inflammation)
Scleroderma (chronic, autoimmune connective tissue disease that causes excess collagen production)
Mixed connective tissue disease (an autoimmune disease with characteristics of other autoimmune connective tissue diseases)
Dermatomyositis (a rare inflammatory disease of the skin and muscles)
Thyroid disease (dysfunction of the thyroid gland in the neck)
Atherosclerosis (fatty deposits develop in the arteries)
Buerger’s disease (inflammation of the blood vessels supplying the hands and feet)
Some drugs are also associated with secondary Raynaud’s and include:
Beta-blockers (a class of drugs used for many conditions, including heart conditions, migraine, and anxiety)
Nicotine (addictive substance in tobacco)
Dextroamphetamine (an attention deficit hyperactivity disorder, or ADHD, medication)
Deseril, Sansert (methysergide) (migraine medications)
Illustration by Emily Roberts, Verywell
Raynaud’s Phenomenon Symptoms
Raynaud’s phenomenon symptoms occur in episodes and that typically follow a pattern, such as:
First, the affected area, like a finger, will turn pale or white as blood flow is restricted. In a person with a darker skin tone, it may be pale or ashen.
As the oxygen in the remaining blood flow is lost, the affected area becomes blue in lighter skin tones or dusky in darker skin tones and feels cold and numb. The area may also be painful.
When circulation returns, the affected area will turn turn red in lighter skin tones but may be harder to detect in darker skin tones. The affected area may feel hot, tingly, or numb and may swell.
Sometimes, an attack may spread from one finger or toe to another and last minutes to hours. The pain levels of each attack can vary.
In some cases, small sores may develop on the affected areas and linger after an attack. Rarely an attack can cause gangrene, where the tissue dies.
Gangrene usually occurs with secondary Raynaud’s after an extended attack in which the affected area lacks oxygen for days at a time.
What Causes Raynaud’s Phenomenon?
While the exact cause of Raynaud’s phenomenon is unknown, factors are related to developing Raynaud’s. These factors differ depending on the type of Raynaud’s.
Primary Raynaud’s Disease Causes
For people with primary Raynaud’s, there is often no underlying reason except exposure to cold. However, certain risk factors can influence who experiences Raynaud’s.
People assigned female at birth and people under the age of 30 are more likely to develop primary Raynaud’s. The male risk for developing Raynaud’s increases with age and is often due to work exposures, such as frequent jackhammer use.
A Note on Gender and Sex Terminology
Verywell Health acknowledges that sex and gender are related concepts, but they are not the same. To reflect our sources accurately, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.
Secondary Raynaud’s Syndrome Causes
Secondary Raynaud’s occurs due to an underlying condition. Characteristics of these underlying conditions cause the body to respond with a typical Raynaud’s attack.
These underlying conditions typically fall into one of three categories—cardiovascular conditions, autoimmune conditions, and blood and plasma conditions. People who have a condition such as these are more likely to develop Raynaud’s syndrome.
What Are the Risk Factors for Raynaud’s Phenomenon?
Certain factors may increase the risk of developing Raynaud’s phenomenon, including age, smoking, and underlying conditions.
People under the age of 30 are more likely to develop primary Raynaud’s. Females are at higher risk of developing Raynaud’s, as are people with a family history of the disease.
Smoking is associated with a higher risk of Raynaud’s. Cardiovascular disease has also been associated with Raynaud’s. People who work with vibrating tools, such as a jackhammer, or perform manual labor are also at risk.
Those with underlying autoimmune conditions that affect the connective tissues, such as lupus and scleroderma, are also more likely to experience Raynaud’s.
How Raynaud’s Phenomenon Is Diagnosed
There is no single test to diagnose Raynaud’s. Instead, a healthcare provider will go through a process to determine if you have Raynaud’s. If the diagnosis is positive, your provider will distinguish whether it is primary or secondary Raynaud’s.
Physical Exam
A healthcare provider will conduct a physical exam to look for any permanent damage caused by Raynaud’s such as sores on the fingers or gangrene.
They may also look for indications of other underlying diseases that can cause secondary Raynaud’s, such as a malar, or butterfly rash on the face, in lupus.
Medical History
A full medical history is often the most telling part of the diagnostic process.
A healthcare provider will ask for details of Raynaud’s attacks, their frequency and location and how long they last to establish an increased sensitivity to cold and a history of experiencing discoloration of the fingers or affected areas.
They will also look at risk factors such as sex, family history, and occupation.
Diagnostic Testing
Diagnostic tests can help distinguish between primary and secondary Raynaud’s. A nailfold capillary microscopy test looks at the small blood vessels in the nails. Changes in these capillaries can be a sign of secondary Raynaud’s.
Blood tests may also be used to determine if an underlying condition is causing Raynaud’s. The blood tests will vary depending on the suspected condition. The most used test is the antinuclear antibody (ANA) test, which can indicate autoimmune diseases associated with Raynaud’s.
How Raynaud’s Phenomenon Is Treated
While there is no cure for Raynaud’s phenomenon, there are ways to reduce the number and frequency of attacks, prevent lasting injury, and treat rare, severe injuries such as gangrene.
Most people with primary Raynaud’s can manage the disease with lifestyle changes. For those with secondary Raynaud’s, other treatment options may be necessary.
Medications
While not frequently prescribed, some medications have shown to be effective when other nondrug treatments fail to work. These include calcium channel blockers such as Procardia XL (nifedipine) and adrenoreceptor antagonists like Minipress (prazosin). These medications can reduce the number and intensity of attacks.
Infusions
In severe cases of Raynaud’s, intravenous medication may be the best treatment option, but it also comes with increased side effects. These medications are often called infusions and can decrease the frequency and severity of attacks.
Infusion medications that have been used for Raynaud’s include:
Epoprostenol
Iloprost
Trepostinil
Surgery
For severe Raynaud’s a procedure called a sympathectomy may be used. This surgery destroys the nerves that trigger the blood vessels to narrow and restrict blood flow, reducing or eliminating attacks. Surgery may also be used to remove dead or infected tissue from severe attacks.
Lifestyle Changes to Manage Raynaud’s Phenomenon
Through lifestyle changes, many people can reduce the number of attacks they experience with Raynaud’s phenomenon.
Lifestyle modifications include:
Avoiding the cold
Wearing thicker clothing or gloves if you must be in the cold, even in an air-conditioned office or home
Quitting smoking
When you experience an attack, treat it immediately. To shorten the duration of the attack, find a way to warm the affected areas as quickly as possible.
To warm fingers experiencing an attack, place them under warm water or under the armpits. You can also use a heating pad for your hands or feet.
How to Avoid Raynaud’s Phenomenon Triggers
Avoiding Raynaud’s phenomenon triggers takes some planning and knowledge of how certain situations and medications can affect the condition.
Cold is a known trigger. Taking steps to avoid the cold can be helpful. This includes:
Dressing warmly to keep your entire body, especially your core, warm
Using gloves or other protection when handling frozen items
Utilizing heated gloves or hand warmers
Bringing layers such as a jacket or hat with you when you visit air-conditioned buildings
Stress is another trigger. Learning to manage stress can help with triggers as well. Stress management techniques include meditation, breath work, exercise, and working with a mental health professional.
Some medications can trigger attacks. Speak to your healthcare provider before starting a new medication.
Common medications known to trigger attacks include:
Decongestants that contain phenylephrine or pseudophedrine
Appetite suppressants with pseudophedrine
Beta-blockers
Migraine medications with ergotamine
Stimulants used for ADHD that contain methylphenidate
What’s the Outlook for Someone With Raynaud’s Phenomenon?
The long-term outlook and prognosis for people with Raynaud’s depends on the severity and the type.
Primary Raynaud’s is a benign condition. People with primary Raynaud’s typically have no lasting effects of the condition.
However, some people living with primary Raynaud’s long-term will go on to show signs of an underlying condition that was yet to be diagnosed. In those cases, the diagnosis becomes secondary Raynaud’s.
The outlook can be more complicated for people with secondary Raynaud’s. In these instances, there is a higher likelihood of developing scarring or pitting of the fingers due to long-lasting and frequent attacks.
The underlying condition also carries its own outlook, which should be considered as well.
Summary
Raynaud’s phenomenon is a condition in which a trigger, such as the cold, restricts blood flow to the blood vessels in the hands or feet.
This results in an attack that causes the affected area to pale, then turn cyanotic (blue or dusky) and numb, and eventually become warm, red (or darkened), and possibly swollen as blood flow returns. These attacks can last from minutes to hours.
Primary Raynaud's occurs for no known reason, while secondary Raynaud's is caused by an underlying condition such as scleroderma. Diagnosis of the condition requires a physical exam, a full medical history, and diagnostic testing.
Treatments for Raynaud’s include avoiding triggers, treating the underlying condition, and medications. Lifestyle changes such as avoiding the cold and reducing stress can help minimize the number, frequency, and severity of attacks.
The long-term outlook for people with Raynaud’s depends on severity and type. Primary Raynaud’s is often benign, while secondary Raynaud’s can lead to complications and is subject to the symptoms of the underlying condition as well.
Read the original article on Verywell Health.
