Raynaud's phenomenon
Your health expert: Dr Sundeept Bhalara, Consultant Rheumatologist
Content editor review by Rachael Mayfield-Blake, Freelance Health Editor, October 2023.
Next review due October 2026.
Raynaud’s phenomenon (Raynaud’s syndrome) is a condition where sometimes blood doesn’t flow as it should to your hands and feet, and sometimes other parts of your body. When it’s cold, or sometimes if you’re anxious or stressed, your fingers and toes may feel numb and cold, and look pale or white.
About Raynaud’s phenomenon
When it’s cold, your body reacts by restricting blood flow to your skin to prevent more heat-loss from your body to maintain your core body temperature. This is normal. But if you have Raynaud’s phenomenon, the small blood vessels in extremities, such as your hands, feet, fingers or toes, are over-sensitive to even the slightest changes in temperature.
You have a more extreme reaction to cold temperatures and sometimes stress. It can cause a noticeable change of colour in affected areas, and your skin may turn white, then blue and finally red as your circulation comes back. This is known as a Raynaud's attack. And your skin can feel different too.
Raynaud’s phenomenon, also known as Raynaud’s syndrome and Raynaud’s disease, is common and doesn’t usually cause serious problems. But sometimes it can be a sign of a more serious health condition.
You can often treat the symptoms yourself by keeping warm and avoiding cold temperatures (where possible).
Causes of Raynaud’s phenomenon
Raynaud’s phenomenon is caused by your body restricting blood flow to your extremities, most often your fingers and toes. The blood vessels in your fingers and toes, for example, constrict. Raynaud’s phenomenon can either be a condition on its own (primary), which is most common, or it develops as a result of having another condition (secondary Raynaud’s) .
The exact cause of primary Raynaud’s phenomenon isn’t known but some things can increase your risk, such as if you:
- were born female
- have another member of your family with Raynaud’s
- smoke
- have migraines
Secondary Raynaud’s phenomenon can be associated with other health conditions or actions, which include:
- taking certain types of medicines, such as medicines for migraines or beta-blockers
- inflammatory health conditions, such as rheumatoid arthritis , scleroderma or lupus
- carpal tunnel syndrome
- an underactive thyroid
- using vibrating tools at work
Things that can trigger Raynaud’s phenomenon are:
- cold temperatures
- emotional stress
- vibration
Symptoms of Raynaud’s phenomenon
Symptoms of Raynaud's include the following.
- Pale or white fingers (not usually your thumb), and/or toes, usually starting at the tip and then spreading down. Your skin may then turn blue, and finally red when the blood returns.
- You may feel cold in the affected area, for example you may have cold fingers.
- Numbness in the affected area.
- Pins and needles when the blood starts to flow again.
- Pain – this can feel like a burning pain as the blood starts to come back.
These symptoms may last from a few minutes to a few hours.
While the symptoms of Raynaud's usually affect your fingers and toes, they can also affect your hands, feet, ears, nose, lips, tongue and nipples.
Diagnosis of Raynaud’s phenomenon
Your GP will ask about your symptoms and medical history of you and your family (including if you take any medicines). They’ll also examine the affected area. They may look at your fingers, for example, using a type of magnifying scope.
Your GP may try to create the conditions when you get Raynaud’s by putting your hands in cold water or cool air for one minute. It can also help to take a photo of when you get an attack of Raynaud’s to show your doctor. They may take your blood pressure too.
You may need to have a blood test and other tests to rule out other health conditions. Raynaud’s disease can sometimes be a sign of a more serious condition, such as scleroderma. Your GP will explain these to you, and may refer you to a specialist doctor, such as a rheumatologist.
Self-help for Raynaud’s phenomenon
Raynaud’s phenomenon can be reversed if you remove the trigger, for example you warm your hands up. This will speed up your recovery so your fingers (if these are affected) return to a normal colour and feel back to normal.
There are also some things you can do to help with Raynaud’s disease, which may be all you need to do if you have mild Raynaud’s. For example:
- try to avoid exposure to the cold and sudden changes in temperature
- keep your whole body warm at home and wear warm clothes in cold weather, including warm mittens and socks
- use hand and foot warming devices, such as pocket hand warmers
- get plenty of exercise
- try to manage stress with relaxation techniques, such as breathing exercises
- eat a healthy diet
- don’t smoke
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Treatment of Raynaud’s phenomenon
Medicines
If the self-help measures above don’t help, you may need to take medicines to treat Raynaud’s phenomenon to try and improve your circulation. These medicines will aim to reduce the number and severity of Raynaud’s attacks and prevent any damage to your tissues.
An example of Raynaud’s phenomenon treatment is a medicine called nifedipine, which is a calcium-channel blocker type of medicine. You take this as a tablet, usually three times a day, long-term, or just in cold weather. To begin with, your doctor will give you a low dose and gradually increase this if necessary. If you have primary Raynaud’s phenomenon, you might be able to stop nifedipine treatment altogether every now and then and see if the disease goes away.
You may get side-effects from nifedipine, such as a racing heartbeat (palpitations), a headache, or dizziness. If you can’t cope with these side-effects, an alternative medicine you could try is amlodipine. There are other options too, which include both tablets and ointments you can put directly on your skin.
Examples of other medicines for Raynaud’s phenomenon include:
- naftidrofuryl oxalate, a 5HT2 receptor antagonist type of medicine, that may improve blood flow in your body
- prazosin, which is an alpha-blocker type of medicine and works by blocking certain nerve impulses
- Iloprost, which is a medicine you might need if you have severe Raynaud’s phenomenon, and this is injected into a vein
Ask your doctor to explain what your options are and what the best treatment is for you.
Non-surgical treatments
Digital sympathetic blocks may be an option if medicines haven’t worked for you. A doctor will inject an anaesthetic drug and sometimes a steroid into a specific part of your nervous system that’s connected with your affected body part. Or they may inject onabotulinumtoxin type A (Botox). This will block the action of the nerves that act to restrict blood flow if you have Raynaud’s phenomenon.
You may need to have the procedure again if your symptoms return or persist.
Surgery
If you have severe Raynaud’s phenomenon, an operation may be possible to remove the nerves that cause your blood vessels to constrict. This is called sympathectomy, and is usually only an option if your Raynaud’s is very severe and treatments haven’t worked.
Complications of Raynaud’s phenomenon
Primary Raynaud’s phenomenon doesn’t usually lead to complications but it’s possible secondary Raynaud’s phenomenon can. Complications of Raynaud’s phenomenon include:
- Digital ulcers. A digital ulcer is a break in the skin of your finger. They can be very painful and can get infected.
- Tissue death (gangrene). If you have severe Raynaud’s phenomenon and your finger, for example, doesn’t get enough oxygen, the tissue may die. It would need to be amputated, but this is rare.
Raynaud’s is caused by the blood vessels in your fingers and toes, for example, constricting, which restricts blood flow. It can be a condition on its own (primary), or can develop as a result of another health condition or action (secondary Raynaud’s) . The exact cause of primary Raynaud’s phenomenon isn’t known but some things can increase your risk, such as if you smoke, or have another member of your family with Raynaud’s.
See our causes of Raynaud’s phenomenon section for more information.
A doctor will test for Raynaud’s by asking you questions about your symptoms and medical history. And they’ll examine the affected area with a type of magnifying scope. They may ask you to put your hands in cold water to see if it brings on your symptoms so they can see what happens.
See our symptoms of Raynaud’s phenomenon section for more information.
Extreme tiredness (fatigue) isn't a symptom of Raynaud’s but it may be a sign that you have secondary Raynaud’s. This means Raynaud’s has developed as a result of having another condition . Inflammatory health conditions, such as rheumatoid arthritis, scleroderma or lupus can all cause fatigue.
See our causes of Raynaud’s phenomenon section for more information.
No, Raynaud’s doesn’t usually get worse with age. Primary Raynaud’s phenomenon may even get better with time. How often you get symptoms and how often you get them may lessen with increasing age too. How secondary Raynaud’s phenomenon progresses depends on the cause. It’s possible you may get complications with time.
See our complications of Raynaud’s phenomenon section for more information.
You may get secondary Raynaud’s phenomenon if you take certain medicines. These include medicines for migraines or beta-blockers. If a medicine you take for another health condition is the cause of your Raynaud’s syndrome, or makes it worse, your GP may review it. They’ll see if you need to take it, or if there’s an alternative.
See our causes of Raynaud’s phenomenon section for more information.
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