Fast facts

  • Raynaud's phenomenon is when the blood flow to the fingers is limited, usually because of cold conditions or stress.
  • It is most common in young women.
  • It can occur as an independent condition (primary Raynaud's) or as a complication of an existing medical condition (secondary Raynaud's).
  • Prevention is the best tool for treating Raynaud's phenomenon. It is best that you identify what triggers your symptoms and take care to avoid these triggers.

Stress

The word ‘stress’ can have a variety of meanings, but generally describes the physical and mental responses of the body to a demand placed upon it. Often used to describe conditions where the demand is high or unable to be resolved and creates anxiety and tension.

What is Raynaud's phenomenon?

The body's normal response to cold exposure is to reduce the blood flow to the extremities. Raynaud's phenomenon is a disorder in which the body over-reacts to cold conditions. Small muscles in the arteries that supply the fingers and other extremities to suddenly constrict. This temporarily cuts off the blood supply to these areas.

In some people, Raynaud's can also be caused by stress or emotional upset.

Arteries

A blood vessel carrying blood saturated with oxygen from the heart to the body's tissues.

Stress

The word ‘stress’ can have a variety of meanings, but generally describes the physical and mental responses of the body to a demand placed upon it. Often used to describe conditions where the demand is high or unable to be resolved and creates anxiety and tension.

Causes

In most cases, Raynaud's phenomenon has no underlying cause. This is also known as primary Raynaud's disease.

When it occurs because of an underlying medical condition, this is known as secondary Raynaud's phenomenon. This is more likely to develop after 30 years of age, and can be more serious.

A wide range of factors have been linked to an increased risk of Raynaud's phenomenon.

Underlying medical conditions can include:

Injuries that can increase the risk include:

  • Overuse injuries from activities such as typing, piano playing or using crutches; 
  • Previous injuries, such as a fracture, surgery or frostbite, and;
  • Industrial injuries due to the use of heavy, vibrating machinery such as chainsaws and drills.

Medications and substances that can increase the risk include:

  • Antihypertensive medications such as beta-blockers (including metaprolol and propanol); 
  • Chemicals such as nicotine in cigarettes;
  • Some migraine medications such as ergotamine and sumatriptan;
  • Medications for attention deficit hyperactivity disorder (ADHD), such as methylphenidate;
  • Some nasal decongestants such as ephedrine and phenylephrine;
  • The combined oral contraceptive pill and oestrogen replacement therapy, and;
  • Some chemotherapy medications such as bleomycin.

Atherosclerosis

Fatty deposits within arteries of the body.

Autoimmune conditions

A medical condition in which the body's immune system abnormally targets substances that are normally found within the body.

Beta-blockers

Substances that hinder the activity of hormones such as adrenaline by blocking the beta receptors, found in many organs but particuarly the heart and blood vessels. These are used to treat a range of conditions including high blood pressure and migraines.

Chemotherapy

A medication-based treatment, usually used in the treatment of cancers. There are numerous, different types of chemotherapy drugs that can be prescribed by a specialist. These can commonly be used alongside other cancer treatments such as surgery and radiotherapy.

Contraceptive

A device, method or chemical that prevents pregnancy.

Decongestants

A substance that reduces congestion or swelling in the body, particularly in the nasal cavity.

Fracture

A complete or incomplete break in a bone.

Infections

Entry into the body of microorganisms that can reproduce and cause disease.

Oestrogen

One of a group of steroid hormones involved in the development and maintenance of female sex characteristics. These are the primary female sex hormones.

Primary pulmonary hypertension

A rare condition with no known cause, in which pressure is raised in the pulmonary artery, i.e., the artery that goes from the heart to the lungs. If not treated, it can lead to heart failure and death.

Scleroderma

A rare condition in which excess collagen fibres are produced by the body, affecting the skin and internal organs.

Buerger's disease

A condition that causes inflammation and blood clot formation in blood vessels, typically in the legs.

Frostbite

Tissue damage caused by exposure to extreme cold. It particularly affects extremities such as the nose, fingers and toes.

Risk factors

For primary Raynaud's disease, risk factors include:

  • Being aged between 15-30 years old, although Raynaud's can develop at any point in life; 
  • Being female - women are at an increased risk; 
  • Cold, wet weather and climate, and;
  • Having a family history of primary Raynaud's disease.

For secondary Raynaud's disease, risk factors include:

  • Having an underlying medical condition associated with Raynaud's disease; 
  • Smoking;
  • Some medications (as noted above in 'Causes'), and;
  • Using heavy vibrating equipment.

Signs and symptoms

Most commonly, Raynaud's phenomenon affects the fingers, with symptoms usually starting in one finger before appearing in the others.

Other parts of the body that are more rarely affected include the toes, ears, nose, nipples, face, lips and tongue.

The skin of the affected areas generally changes colour over the course of an 'attack' of Raynaud's phenomenon. Initially, the area goes white as blood flow reduces to the area and then the skin can turn blue or purple. Finally, as blood flow returns, usually after 15-20 minutes, the skin becomes red.

As blood flow returns, other symptoms in the affected areas include:

  • Discomfort or pain, which can be severe;
  • Sensations such as tingling or pins and needles, and;
  • Numbness.

The fingers are commonly affected by Raynaud's phenomenon. 

Methods for diagnosis

To diagnose Raynaud's phenomenon, your doctor will perform a physical examination and ask you questions about your symptoms.

It is important to rule out other causes for the symptoms and identify any underlying causes for Raynaud's phenomenon, and tests may be recommended for this reason.

Tests that can help to identify autoimmune disorders include:

A blood test can be used to identify an underlying medical condition is causing Raynaud's phenomenon.A blood test can be used to identify if an underlying medical condition is causing Raynaud's phenomenon. 

Antinuclear antibody test

A blood test to detect antinuclear antibodies, which are antibodies that target molecules within the body’s cells.

Autoimmune disorders

A medical condition in which the body's immune system abnormally targets substances that are normally found within the body.

Erythrocyte sedimentation rate

A blood test that measures the rate of red blood cell sedimentation at the bottom of a test tube, which is an indicator of the level of inflamation in the body.

Types of treatment

The most effective way to manage Raynaud's phenomenon is to take steps to prevent attacks from occurring.

Learning what triggers your attacks is a good first step. For some people, an attack may occur only during cold weather, while for others it may be exposure to relatively small changes in temperature, such as when entering an air-conditioned building when it is hot outside, or handling frozen items out of the freezer.

Steps to avoid triggers include:

  • Wearing warm clothing, particularly gloves, mittens and thick socks;
  • Avoiding situations where temperatures change rapidly;
  • Taking care when handling cold items;
  • Managing stress and emotional upset;
  • Avoiding medications that can trigger an attack;
  • Avoiding cigarette smoke (both through smoking and passive exposure to smoke), and;
  • Avoiding activities that can damage the fingers and trigger attacks.

The link between caffeine and Raynaud's phenomenon is not clear. Some experts recommend avoiding coffee, while others do not. If you find that drinking coffee appears to trigger attacks, you may wish to avoid it.

Wearing warm clothing can help to treat Raynaud's phenomenon.Wearing warm clothing can help to avoid attacks of Raynaud's phenomenon. 

Managing Raynaud's attacks

To encourage the blood vessels to open up and blood flow to return to the affected areas, it is best to try to warm them gradually.

You can:

  • Bathe them in warm water;
  • Use body heat (such as putting an affected hand in your armpit), and;
  • Rotate your arms like windmills, or rub your hands together to help encourage blood flow.

Medications

If the symptoms of Raynaud's phenomenon cannot be managed well with the measures above, medications may be recommended.

The most common medications are calcium-channel blockers, such as nifedipine or amlodipine, which help to relax the muscle cells in arteries and open them up.

If these are not effective, other medications may be substituted, or added to help open up the arteries. These can include:

  • Sildenafil, known commonly as Viagra® or by other trade names;
  • Nitroglycerin, applied to the skin as an ointment or gel, and;
  • Losartan, a particular blood pressure medication.

Stress management

It is not clear whether psychological treatment is effective for treating Raynaud's attacks. If stress or emotional upset trigger Raynaud's attacks, counselling or using relaxation techniques may be helpful.

More intensive treatment

For people with severe symptoms, or complications such as ulcers, more intensive treatment may be required. This usually only occurs in people who have serious underlying medical conditions such as scleroderma.

More intensive treatments include:

  • Intravenous (IV) infusions of a prostanoid such as iloprost;
  • Sympathectomy - blocking of the nerves that can stimulate a Raynaud's attack with injections such as botulinum toxin (Botox®), or surgery, and;
  • Other medications such as anticoagulants and antibiotics, if necessary.

Complementary and alternative medicines

A range of complementary therapies such as acupuncture, biofeedback, wearing therapeutic gloves, or various herbs such as Ginkgo biloba, have been suggested for treating Raynaud's phenomenon, but there is currently not enough evidence to support the effectiveness of any of these therapies.

Acupuncture

A form of complementary therapy that involves fine sterilised needles being inserted into the skin at specific points to treat medical conditions.

Antibiotics

Chemical substances that kill or suppress the growth of bacteria.

Arteries

A blood vessel carrying blood saturated with oxygen from the heart to the body's tissues.

Biofeedback

A technique designed to help people monitor and control various automatic bodily functions, such as the heart rate and breathing. Electric sensors are used to monitor the body’s response during training with a therapist. It is often used as a relaxation therapy.

Cells

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

Intravenous

Within a vein.

Nerves

One or more fibres that transmit signals of sensation and motion between the brain or spinal cord and other parts of the body.

Psychological

Relating to, arising in, or affecting the mind.

Scleroderma

A rare condition in which excess collagen fibres are produced by the body, affecting the skin and internal organs.

Stress

The word ‘stress’ can have a variety of meanings, but generally describes the physical and mental responses of the body to a demand placed upon it. Often used to describe conditions where the demand is high or unable to be resolved and creates anxiety and tension.

Ulcers

An open sore in the skin or mucous membranes such as those of the stomach lining, intestine or mouth.

Calcium-channel blockers

Also called a calcium antagonist. A group of medications that is used to treat high blood pressure and other conditions. It works by blocking calcium from entering cells of the heart and blood vessels, which ultimately lowers blood pressure.

Potential complications

Primary Raynaud's disease is normally a minor complaint; complications are extremely rare.

In severe secondary Raynaud's disease, if blood flow cannot be restored to the affected area (usually the fingers or toes) this can lead to ulceration and gangrene.

If this cannot be managed with more intensive treatments, amputation of the affected area may be necessary.

Amputation

The process of surgically removing an external body part or appendage.

Gangrene

The death of a mass of body tissue, usually resulting from obstructed blood supply or bacterial infection.

Ulceration

The formation of an ulcer, which is an open sore in the skin or mucous membranes, such as those of the stomach lining, intestine or mouth.

Prognosis

Most people who have Raynaud's attacks have the less serious primary form that can be managed well by avoiding triggers. In some cases, the symptoms will improve over time, with women often finding that symptoms noticeably reduce with menopause. However, some people have lifelong symptoms.

Secondary Raynaud's disease can be much more serious and may require more intensive treatment. It can lead to ulceration and, in very severe cases, may require amputation.

Amputation

The process of surgically removing an external body part or appendage.

Menopause

The point in a woman's life when she stops menstruating.

Ulceration

The formation of an ulcer, which is an open sore in the skin or mucous membranes, such as those of the stomach lining, intestine or mouth.

Prevention

If you have Raynaud's attacks, learning about your triggers and avoiding them can help to reduce your symptoms.