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For more information, visit http://www.nhlbi.nih.gov/health/health-topics/topics/raynaud/


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 sometimes is called a disease, syndrome, or phenomenon. The disorder is marked by brief episodes of vasospasm (VA-so-spazm), which is a 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

There are two main types of Raynaud’s—primary and secondary.

In primary Raynaud’s (also called Raynaud’s disease), the cause isn't known. Primary Raynaud's is more common and tends to be less severe than secondary Raynaud's.

Secondary Raynaud’s is caused by an underlying disease, condition, or other factor. This type of Raynaud's is often called Raynaud's phenomenon.

If you have primary or secondary Raynaud's, cold temperatures or stress 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 throb, tingle, burn, or feel numb.

In both types of Raynaud's, even mild or brief changes in temperature can cause Raynaud's 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.

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 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?

There are two main types of Raynaud’s—primary and secondary.

In primary Raynaud’s (also called Raynaud’s disease), the cause isn't known. Primary Raynaud's is more common and tends to be less severe than secondary Raynaud's. 

Secondary Raynaud’s is caused by an underlying disease, condition, or other factor. This type of Raynaud's is often called Raynaud's phenomenon.

Causes of Secondary Raynaud's

Many things can cause secondary Raynaud's. Examples include:

  • 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. The disorder also is linked to diseases and conditions that damage the nerves that control the arteries in the hands and feet.

For example, Raynaud’s occurs in most people who have scleroderma (skler-o-DER-ma). It also is a common problem for people with lupus.

Other examples of diseases and conditions that can cause 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

Thyroid problems and pulmonary hypertension also may cause Raynaud's.

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 of developing 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 this type of chemical is vinyl chloride, which is used in the plastics industry.

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

Medicines

Certain medicines can cause 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. Women are more likely to have primary Raynaud's than men.
  • 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 example, 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, go to "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 to other fingers or toes. Sometimes only one or two fingers or toes are affected. Different areas may be affected at different times.

Severe 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 test results.

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 are 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:

  • Feel numb or painful when they're exposed to cold temperatures
  • Turn white or 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 normal temperature. If you have Raynaud's, it may take more than 20 minutes for your fingers to return to their normal temperature.

Because results of this type of test are not always consistent, your doctor may do other tests to check for Raynaud’s.

Nailfold Capillaroscopy

You may have a test called nailfold capillaroscopy (KAP-ih-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 order blood 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) blood 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

To protect yourself from cold temperatures:

  • 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 warmers 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 things 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 with your doctor about whether your medicines 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 stop 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, be sure 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.

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) can be lifelong conditions. 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 disorder 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, go to "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. Also, try to avoid secondhand smoke.

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, be sure 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, go to "How Is Raynaud's Treated?"

Ongoing Care

If you have Raynaud's, it's important to get ongoing care. Talk with 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.




Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.

NHLBI-supported research has led to many advances in medical knowledge and care. Often, these advances depend on the willingness of volunteers to take part in clinical trials.

Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions. For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.

By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.

If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.

If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.

For more information about clinical trials related to primary or secondary Raynaud's, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:

For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.




Links to Other Information About Raynaud's

Non-NHLBI Resources

Clinical Trials

 
March 21, 2014 Last Updated Icon

The NHLBI updates Health Topics articles on a biennial cycle based on a thorough review of research findings and new literature. The articles also are updated as needed if important new research is published. The date on each Health Topics article reflects when the content was originally posted or last revised.

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