All About Raynaud’s Phenomenon

May 1, 2023 | Rheumatic DiseaseRaynaud's


Many people have cold hands, but Raynaud’s phenomenon is more than that. This condition of “cold sensitivity” of the hands is characterized by episodes of spasms of the blood vessels in response to the cold. Raynaud’s most frequently involves the fingers, but it can also affect the toes, and more rarely the nose or tongue. Some people find that stress can be a trigger for Raynaud’s phenomenon.

If you experience Raynaud’s phenomenon, you may have these common questions:

What is happening to my fingers when they get cold?

Exposure to cold causes the blood vessels to spasm or narrow. With the narrowing of the blood vessels, there is reduced blood flow to the fingers. This can then cause the fingertips to turn white from the reduced blood flow (blanching). With reduced blood supply to the tissues in the fingers, the fingers may then turn blue (tissue ischemia). When the blood vessels then return to their usual size and more sufficient blood flow is regained, there may be a red color change as blood flow returns to the tissues. Not everyone will experience all three phases of white, blue, and red discoloration. Many people will have at least two phases, and discomfort and tingling are common with these episodes.

Who gets Raynaud’s phenomenon?

Raynaud’s phenomenon affects women more than men. It usually has its onset in a person’s teens or early twenties and occurs for people in any number of climates―not just the cold ones! That said, some people with Raynaud’s phenomenon notice that the high use of air conditioners in warmer climates can be quite problematic!

How does Raynaud’s phenomenon relate to other disorders?

Primary Raynaud’s phenomenon is the most common form, occurring in people who do not have another underlying condition or disease. Secondary Raynaud’s phenomenon occurs in people who have features of an underlying disease or have a disease diagnosis that is associated with this condition―like scleroderma, dermatomyositis/polymyositis, systemic lupus erythematosus, rheumatoid arthritis, or Sjögren’s syndrome. Some medications can also contribute to the symptoms. Tobacco use has been proven to lead to cold-induced vasospasm and should be discontinued.

How is Raynaud’s phenomenon evaluated?

The diagnosis of Raynaud’s phenomenon is made clinically. That means that your healthcare provider will listen to your description of symptoms and recognize that you have Raynaud’s phenomenon. Your provider will also likely ask you other questions to determine if there are hints of another underlying condition that may be associated with Raynaud’s phenomenon. A physical examination can be helpful to evaluate you for findings of associated disorders.

Some providers may evaluate your nailfold capillaries. This is a test that is done in the office using a dermatoscope, ophthalmoscope, or widefield microscope. The instrument used allows closer visualization of the small blood vessels (capillaries) on the skin at the base of your fingernails. There are a few characteristic changes in the nailfold capillaries that can be seen in some conditions associated with Raynaud’s phenomenon.

Does having Raynaud’s phenomenon also mean I have rheumatic disease?

While there is not a lab test diagnostic of Raynaud’s phenomenon, there are some lab tests that your provider may request to evaluate you for other associated conditions. In the absence of examination and lab findings to raise consideration of an underlying autoimmune disease, it may be determined that you have primary Raynaud’s phenomenon. Remember, primary Raynaud’s phenomenon is most common and is not associated with other autoimmune diseases.

Are there complications of Raynaud’s phenomenon?

Raynaud’s phenomenon can be uncomfortable but for people with primary Raynaud’s phenomenon, it is not associated with complications or damage to the skin and soft tissues. For people with secondary Raynaud’s phenomenon, they can experience slow healing of cuts or sores on the fingers, digital ulcers (sores on the fingertips), digital pits (small indentations of the soft tissue on the tip of the finger related to ischemic damage to the tissue), and in very severe cases, there can be tissue gangrene.

What can be done to manage Raynaud’s phenomenon?

First, keep your hands warm! This can be accomplished with gloves, mittens, and/or hand warmers. In general, mittens are more efficient than gloves to keep the hands and fingers warm. Making sure that you limit your exposure to cold environments is also important. Keeping your core body warm will serve to dilate the blood vessels to the hands, so wearing layers to keep your torso warm can be very helpful. People with primary Raynaud’s phenomenon can manage the symptoms more conservatively by keeping the hands and core body warm. You should avoid substances, such as tobacco, that can cause vasoconstriction (narrowing of blood vessels).

There are also medications that help to dilate the blood vessels to the hands and fingers. These medications are typically reserved for people with secondary Raynaud’s phenomenon. There are topical medications as well as tablets. Rarely, intravenous medications may be considered for highly potent blood vessel dilation. Medications that inhibit platelet function, such as aspirin, may be used. The determination for medications should be made with your healthcare provider(s).

Be sure to raise any questions you have with your physician and stay warm!

Marcy Bolster, MD

About the Author

Marcy Bolster, MD

Dr. Marcy Bolster is Director, Rheumatology Fellowship Training Program at Massachusetts General Hospital and serves on the American College of Rheumatology (ACR) Committee on Communications and Marketing.

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