What Is Raynaud's?

Raynaud's is a rare disorder that affects the arteries. Arteries are blood vessels that carry blood from your heart to different parts of your body.

Raynaud's is sometimes called a disease, syndrome, or phenomenon. The disorder is marked by brief episodes of vasospasm (narrowing of the blood vessels).

Vasospasm of the arteries reduces blood flow to the fingers and toes. In people who have Raynaud's, the disorder usually affects the fingers. In about 40 percent of people who have Raynaud's, it affects the toes. Rarely, the disorder affects the nose, ears, nipples, and lips.

Overview

In most cases, the cause of Raynaud's isn't known. This type of Raynaud's is called Raynaud's disease or primary Raynaud's.

Sometimes, a disease, condition, or other factor causes Raynaud's. This type of Raynaud's is known as Raynaud's phenomenon or secondary Raynaud's. Primary Raynaud's is more common and tends to be less severe than secondary Raynaud's.

If you have primary or secondary Raynaud's, cold temperatures or stressful emotions can trigger “Raynaud's attacks.” During an attack, little or no blood flows to affected body parts.

As a result, the skin may turn white and then blue for a short time. As blood flow returns, the affected areas may turn red and may throb, tingle, burn, or feel numb.

In both types of Raynaud's, even mild or brief changes in temperature can cause attacks. For example, taking something out of the freezer or being exposed to temperatures below 60 degrees Fahrenheit can cause your fingers to turn blue.

Raynaud's

Figure A shows arteries in the fingers (digital arteries) with normal blood flow. The inset image shows a cross-section of a digital artery. Figure B shows fingertips that have turned white due to blocked blood flow. Figure C shows narrowed digital arteries, causing blocked blood flow and blue fingertips. The inset image shows a cross-section of a narrowed digital artery.

Most people who have Raynaud's have no long-term tissue damage or disability. However, people who have severe Raynaud's can develop skin sores or gangrene from prolonged or repeated Raynaud's attacks. “Gangrene” refers to the death or decay of body tissues.

Outlook

About 5 percent of the U.S. population has Raynaud's. For most people who have primary Raynaud's, the disorder is more of a bother than a serious illness. They usually can manage the condition with minor lifestyle changes.

Secondary Raynaud's may be harder to manage. However, several types of treatments are available to help prevent or relieve symptoms. With secondary Raynaud's, it's important to treat the underlying disease or condition that's causing it.

Researchers continue to look for better ways to diagnose and treat Raynaud's.

What Causes Raynaud's?

In most cases, the cause of Raynaud's isn't known. This type of Raynaud's is called Raynaud's disease or primary Raynaud's.

Sometimes a disease, condition, or other factor causes Raynaud's. This type of Raynaud's is called Raynaud's phenomenon or secondary Raynaud's.

Causes of Secondary Raynaud's

A number of different things can cause secondary Raynaud's, such as:

• Diseases and conditions that directly damage the arteries or damage the nerves that control the arteries in the hands and feet
• Repetitive actions that damage the nerves that control the arteries in the hands and feet
• Injuries to the hands and feet
• Exposure to certain chemicals
• Medicines that narrow the arteries or affect blood pressure

Diseases and Conditions

Secondary Raynaud's is linked to diseases and conditions that directly damage the arteries or damage the nerves that control the arteries in the hands and feet.

Scleroderma (skler-o-DER-ma) and lupus are two examples of conditions that are linked to Raynaud's. About 9 out of 10 people who have scleroderma have Raynaud's. About 1 out of 3 people who has lupus has Raynaud's.

Other examples of diseases and conditions linked to Raynaud's include:

• Rheumatoid (RU-ma-toyd) arthritis
• Atherosclerosis (ath-er-o-skler-O-sis)
• Blood disorders, such as cryoglobulinemia (KRI-o-GLOB-yu-li-NE-me-ah) and polycythemia (POL-e-si-THE-me-ah)
• Sjögren's (SHOW-gren's) syndrome, dermatomyositis (DER-ma-to-mi-o-SI-tis), and polymyositis (POL-e-mi-o-SI-tis)
• Buerger's disease

Raynaud's also has been linked to thyroid problems and pulmonary hypertension.

Repetitive Actions

Repetitive actions that damage the arteries or the nerves that control the arteries in the hands and feet may lead to Raynaud's.

Typing, playing the piano, or doing other similar movements repeatedly over long periods may lead to secondary Raynaud's. Using vibrating tools, such as jackhammers and drills, also may raise your risk for Raynaud's.

Hand or Foot Injuries

Injuries to the hands or feet from accidents, frostbite, surgery, or other causes can lead to Raynaud's.

Chemicals

Exposure to certain workplace chemicals can cause a scleroderma-like illness that's linked to Raynaud's. An example of such a chemical is vinyl chloride. This chemical is used in the plastics industry.

The nicotine in cigarettes also can raise your risk for Raynaud's.

Medicines

Several medicines are linked to secondary Raynaud's, including:

• Migraine headache medicines that contain ergotamine. This substance causes the arteries to narrow.
• Certain cancer medicines, such as cisplatin and vinblastine.
• Some over-the-counter cold and allergy medicines and diet aids. Some of these medicines can narrow your arteries.
• Beta blockers. These medicines slow your heart rate and lower your blood pressure.
• Birth control pills. These medicines can affect blood flow.

Who Is At Risk for Raynaud's?

The risk factors for primary Raynaud's (Raynaud's disease) and secondary Raynaud's (Raynaud's phenomenon) are different.

The risk factors for primary Raynaud's include:

• Gender. About 80 percent of people who have primary Raynaud's are women.
• Age. Primary Raynaud's usually develops before the age of 30.
• Family history. Primary Raynaud's may occur in members of the same family.
• Living in a cold climate. Cold temperatures can trigger Raynaud's attacks.

The risk factors for secondary Raynaud's include:

• Age. Secondary Raynaud's usually develops after the age of 30.
• Certain diseases and conditions. For examples, diseases that directly damage the arteries or damage the nerves that control the arteries in the hands and feet may cause secondary Raynaud's. (For more information, see "What Causes Raynaud's?")
• Injuries to the hands or feet.
• Exposure to certain workplace chemicals, such as vinyl chloride (used in the plastics industry).
• Repetitive actions with the hands, such as typing or using vibrating tools.
• Certain medicines, such as migraine, cancer, cold/allergy, or blood pressure medicines.
• Smoking.
• Living in a cold climate.

What Are the Signs and Symptoms of Raynaud's?

People who have primary Raynaud's (Raynaud's disease) or secondary Raynaud's (Raynaud's phenomenon) can have attacks in response to cold temperatures or emotional stress.

Raynaud's attacks usually affect the fingers and toes. Rarely, the attacks affect the nose, ears, nipples, or lips.

During a Raynaud's attack, the arteries become very narrow for a brief period. As a result, little or no blood flows to affected body parts. This may cause these areas to:

• Turn pale or white and then blue
• Feel numb, cold, or painful
• Turn red, throb, tingle, burn, or feel numb as blood flow returns to the affected areas

Raynaud's attacks can last less than a minute or as long as several hours. Attacks can occur daily or weekly.

Attacks often begin in one finger or toe and move on to other fingers or toes. Sometimes only one or two fingers or toes are affected. Different areas may be affected at different times.

Severe cases of secondary Raynaud's can cause skin sores or gangrene. "Gangrene" refers to the death or decay of body tissues. Fortunately, severe Raynaud's is rare.

How Is Raynaud's Diagnosed?

Your doctor will diagnose primary Raynaud's (Raynaud's disease) or secondary Raynaud's (Raynaud's phenomenon) based on your medical history, a physical exam, and the results from tests.

Specialists Involved

Primary care doctors and internists often diagnose and treat Raynaud's.

If you have the disorder, you also may see a rheumatologist. This is a doctor who specializes in treating disorders of the joints, bones, and muscles.

Rheumatologists diagnose and treat many of the diseases that may be linked to secondary Raynaud's, such as scleroderma and lupus.

Medical History

Your doctor may ask about your risk factors for Raynaud's. He or she also may ask about your signs and symptoms when you're exposed to cold temperatures or stress.

For example, your doctor may ask whether your fingers or toes:

• Change color or feel numb or painful when they're exposed to cold temperatures
• Turn white, blue, or both when they're exposed to cold temperatures

Physical Exam

Your doctor will look at your fingers and toes to check the health of your skin and nails and to check blood flow to these areas.

Your doctor also may do a more complete physical exam to check for signs of diseases and conditions that are linked to secondary Raynaud's.

Diagnostic Tests and Procedures

Your doctor may recommend the following tests to check for Raynaud's and related conditions.

Cold Stimulation Test

A cold stimulation test can be used to trigger Raynaud's symptoms. For this test, a small device that measures temperature is taped to your fingers. Your hands are then exposed to cold—they're usually briefly put into ice water.

Your hands are then removed from the cold, and the device measures how quickly your fingers return to their original temperature. If you have Raynaud's, it may take more than 20 minutes for your fingers to return to their original temperature.

Nailfold Capillaroscopy

Your doctor may do a test called nailfold capillaroscopy (KAP-i-lar-OS-ko-pe). For this test, your doctor puts a drop of oil at the base of your fingernail. He or she then looks at your fingernail under a microscope.

If your doctor sees abnormal arteries, it may mean you have a disease linked to Raynaud's, such as scleroderma.

Other Tests

Your doctor may use other tests to look for conditions that are linked to secondary Raynaud's. Examples include antinuclear antibody (ANA), erythrocyte sedimentation rate (ESR or “sed rate”), and C-reactive protein (CRP) tests.

How Is Raynaud's Treated?

Primary Raynaud’s (Raynaud’s disease) and secondary Raynaud's (Raynaud’s phenomenon) have no cure. However, treatments can reduce the number and severity of Raynaud’s attacks. Treatments include lifestyle changes, medicines, and, rarely, surgery.

Most people who have primary Raynaud’s can manage the condition with lifestyle changes. People who have secondary Raynaud's may need medicines in addition to lifestyle changes. Rarely, they may need surgery or shots.

If you have Raynaud's and develop sores on your fingers, toes, or other parts of your body, see your doctor right away. Timely treatment can help prevent permanent damage to these areas.

Lifestyle Changes

Lifestyle changes can help you avoid things that may trigger a Raynaud's attack. Examples of such triggers include cold temperatures, emotional stress, workplace or recreational factors, and contact with certain chemicals or medicines.

Protect Yourself From Cold Temperatures

You can take steps to protect yourself from cold temperatures. For example:

• Wear a hat, mittens (rather than gloves), scarf, coat with snug cuffs, and warm socks and shoes during cold weather. Layer your clothing for extra warmth.
• Put hand and foot warmers in your mittens, boots, socks, or pockets. Some warmers are small heat packs, and others are battery-operated. These heat packs often are available at sporting goods stores.
• Turn down air conditioning or dress warmly while in an air-conditioned space.
• Warm up your car before driving in cold weather.
• Wear gloves or mittens when taking food out of the refrigerator or freezer (if cold temperatures severely affect you).

Avoid Other Triggers

Try to avoid situations that make you upset or stressed. Learn ways to handle stress that you can’t avoid. Physical activity helps some people cope with stress. Other people listen to music or focus on something calm or peaceful to reduce stress. Some people learn yoga, tai chi, or meditation.

Try to avoid workplace and recreational triggers. For example, limit the use of vibrating tools, such as drills. Wear proper protective gear if you work with industrial chemicals. Also, try to limit repetitive hand actions, such as typing or playing the piano.

Some medicines can trigger Raynaud’s attacks. Examples include:

• Migraine headache medicines that contain ergotamine. This substance causes your arteries to narrow.
• Certain cancer medicines, such as cisplatin and vinblastine.
• Over-the-counter cold or allergy medicines or diet aids. Some of these medicines can narrow your arteries.
• Beta blockers. These medicines slow your heart rate and lower your blood pressure.
• Birth control pills. These medicines can affect blood flow.

Talk to your doctor about medicines that are safe for you.

Other Lifestyle Changes

Other lifestyle changes also can help you avoid Raynaud’s attacks. For example, include physical activity as part of your healthy lifestyle. Physical activity can increase your blood flow and help keep you warm.

Limit your use of caffeine and alcohol. These substances can trigger Raynaud’s attacks. If you smoke, quit. Smoking makes Raynaud’s worse. Ask your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke.

You also can take steps to help end Raynaud’s attacks when they occur. For example:

• Move to a warmer spot, such as indoors, during cold weather.
• Warm your hands or feet. Place your hands under your armpits. Soak your feet or hands in warm water.
• Wiggle or massage your fingers and toes.
• Move your arms in circles or shake your arms or feet.
• Get out of stressful situations and try relaxation techniques.

If you have Raynaud’s, taking care of your hands and feet is important. Protect them from cuts, bruises, and other injuries. For example, wear properly fitted shoes and don’t walk barefoot. Use lotion to prevent your skin from drying and cracking. Also, avoid tight wristbands and rings.

Medicines and Surgery

If lifestyle changes don’t control Raynaud’s, you may need medicines or surgery. Medicines are used to improve blood flow to the fingers and toes.

Examples of medicines used to treat Raynaud’s include calcium channel blockers, alpha blockers, prescription skin creams, and ACE inhibitors (used less often).

Rarely, people who have severe Raynaud’s may develop skin sores or gangrene. “Gangrene” refers to the death or decay of body tissues. If this happens, antibiotics or surgery to cut out the damaged tissue may be needed. In very serious cases, the affected toe or finger may need to be removed.

Another treatment for severe Raynaud’s is to block the nerves in the hands or feet that control the arteries. This can help prevent Raynaud’s attacks. This treatment is done using surgery or shots.

The surgery often relieves symptoms, but sometimes for only a few years. Shots may need to be repeated if symptoms persist or come back.

Living With Raynaud's

Primary Raynaud's (Raynaud's disease) and secondary Raynaud's (Raynaud's phenomenon) are conditions that may be lifelong. However, you can take steps to help control Raynaud's. Lifestyle changes and ongoing care can help you manage the disorder.

Most people who have primary Raynaud's can manage the condition with lifestyle changes. People who have secondary Raynaud's may need medicines in addition to lifestyle changes. Rarely, they may need surgery or shots.

Lifestyle Changes

You can take steps to avoid things that trigger Raynaud's attacks. If you have Raynaud's:

• Protect yourself from cold temperatures.
• Try to avoid emotional stress and learn ways to cope with stress that you can't avoid.
• Avoid certain medicines, substances, and activities that can trigger Raynaud's attacks. (For more information, see "What Causes Raynaud's?")
• Include physical activity as part of your healthy lifestyle and limit your use of caffeine and alcohol. If you smoke, quit.

You also can take steps to stop a Raynaud's attack once it starts. Warm up your hands, feet, or other affected areas right away. For example, place your hands under your armpits, run warm water over your fingers and toes, or massage your hands and feet.

If you have Raynaud's, it's important to take care of your hands and feet. Protect them from cuts, bruises, and other injuries. For example, wear properly fitted shoes and don't walk barefoot. Use lotion to prevent your skin from drying and cracking. Also, avoid tight wristbands and rings.

For more information about lifestyle changes, see "How Is Raynaud's Treated?"

Ongoing Care

If you have Raynaud's, it's important to get ongoing care. Talk to your doctor about how often to schedule followup visits. Take all medicines as your doctor prescribes.

See your doctor right away if your Raynaud's symptoms get worse or if you develop sores on your fingers, toes, or other parts of your body. Timely treatment can help prevent permanent damage to these areas.

Key Points

• Raynaud's is a rare disorder that affects the arteries. The disorder is marked by brief episodes of vasospasm (narrowing of the blood vessels).
• Vasospasm of arteries reduces blood flow to the fingers and toes. Rarely, it affects the nose, ears, nipples, and lips.
• In most cases, the cause of Raynaud's isn't known. This type of Raynaud's is called Raynaud's disease or primary Raynaud's. Sometimes, a disease, condition, or other factor causes Raynaud's. This type of Raynaud's is called Raynaud's phenomenon or secondary Raynaud's.
• If you have primary or secondary Raynaud's, cold temperatures or stressful emotions can trigger "Raynaud's attacks." During an attack, little or no blood flows to affected body parts. As a result, the skin may turn white and then blue for a short time. As blood flow returns, the affected areas turn red and may throb, tingle, burn, or feel numb.
• Primary Raynaud's is more likely to occur in women than in men. It's also more likely to affect people who are younger than 30, have a family history of Raynaud's, or live in a cold climate.
• Secondary Raynaud's is more likely to occur in people older than 30. It's also more likely to occur in people who have diseases or conditions that directly damage the arteries or damage the nerves that control the arteries in the hands and feet.
• Other risk factors for secondary Raynaud's include injuries to the hands or feet, exposure to certain chemicals, repetitive actions, certain medicines, smoking, and living in a cold climate.
• Most people who have Raynaud's have no long-term tissue damage or disability. However, people who have severe secondary Raynaud's may develop skin sores or gangrene. "Gangrene" refers to the death or decay of body tissues. Fortunately, severe Raynaud's is rare.
• Your doctor will diagnose primary or secondary Raynaud's based on your medical history, a physical exam, and the results from tests.
• Primary and secondary Raynaud's have no cure. However, treatments can reduce the number and severity of Raynaud's attacks. Treatments include lifestyle changes, medicines, and surgery.
• Most people who have primary Raynaud's can manage the condition with lifestyle changes. People who have secondary Raynaud's may need medicines in addition to lifestyle changes. Rarely, they may need surgery or shots.
• You can take steps to avoid things that trigger Raynaud's attacks. Protect yourself from the cold and try to avoid emotional stress. Avoid medicines, substances, and activities that can trigger Raynaud's attacks. Include physical activity as part of your healthy lifestyle. Limit your use of caffeine and alcohol, and quit smoking.
• You can help stop a Raynaud's attack once it starts. Warm up your hands, feet, or other affected areas right away. For example, place your hands under your armpits, run warm water over your fingers and toes, or massage your hands and feet.
• If you have Raynaud's, see your doctor for ongoing care and take all medicines as your doctor prescribes. See your doctor right away if your Raynaud's symptoms get worse or if you develop sores on your fingers, toes, or other parts of your body.

Links to Other Information About Raynaud's

Non-NHLBI Resources

• Raynaud's Disease (MedlinePlus)

Clinical Trials

• Current Research (ClinicalTrials.gov)