Raynaud Phenomenon

Cold fingers. Geri Lavrov/Photographer's choice/Getty Images

Raynaud Phenomenon (RP) causes color changes, and often discomfort, in the fingers (and sometimes the toes) when exposed to cold or emotional stress. RP is caused by an exaggerated constriction in the blood vessels of the fingers or toes.

Normally, the blood vessels in the fingers and toes constrict in cold environments, to help maintain your body's core temperature. Constriction of these blood vessels also occurs during periods of sudden stress, which allows more blood to flow to the muscles (in case you need to run away or fight).

In people who have RP, this normal constriction in the blood vessels of the fingers and toes is greatly exaggerated, to the point that symptoms occur.

What Are The Symptoms of Raynaud Phenomenon?

The most striking symptom of RP is a change in the color of the affected digits in response to cold or stress.

There are three characteristic color changes that can occur. Most often, the affected digits (usually fingers) turn a very pale white, as the blood vessels constrict. Then the fingertips may turn a bluish-purplish color, called "cyanosis," which is produced by low oxygen levels in the blood remaining in the fingers. Finally, when the blood vessels begin to open up again, the skin blushes to a deep pink or red color. An episode of Raynaud phenomenon may cause one, any two, or all three of these characteristic color changes.

An attack of RP typically begins in one finger (the index, middle or ring finger), but then usually "spreads" to the other fingers in both hands.

(The thumbs are typically spared, however.) While an attack may also involve the toes, it is much more common for symptoms to be limited to the fingers.

In addition to the color changes, an attack of RP may also be accompanied by numbness, tingling, or clumsiness. Frank pain in the affected fingers is less common, but can occur.

The most common sequence of symptoms with an attack of RP is blanching of the fingers, followed by numbness. Because RP is essentially an exaggeration of a normal response, symptoms vary among affected individuals from being quite mild to quite severe.

While any cold exposure can trigger these attacks, they are much more likely to occur with sudden changes in temperature, such as moving suddenly from a warm room to the cold outdoors.

Symptoms completely resolve within a few minutes after leaving the cold environment (or after the emotional stress passes).

Who Gets Raynaud Phenomenon?

RP is usually seen in otherwise healthy people. It is a fairly common condition, affecting up to 20% of women, and up to 14% of men. It is more commonly seen in younger people and in colder climates. People who suffer from this condition often have family members who also have RP.

What Causes Raynaud Phenomenon?

In most cases, RP is not related to any identifiable underlying disease, but occurs simply because (for unknown reasons) the blood vessels in the digits tend to be overreactive.

This is called primary RP.

Sometimes, however, RP is caused by an underlying medical condition. This is called secondary RP. Conditions that can produce secondary RP include autoimmune conditions such as lupus, connective tissue disorders such as dermatomyositis, vascular disease such as atherosclerosis, prior frostbite, or drugs (including beta blockers, amphetamines, cocaine, or nicotine).

Secondary RP should be suspected when symptoms first appear after age 40, or if the thumbs are affected, or in people who have other signs of any of the medical conditions known to cause RP. Secondary RP can be much more severe than primary RP. Pain is much more common with secondary RP, and secondary RP can lead to actual tissue destruction in the affected fingertips.

How Is The Diagnosis Of Raynaud Phenomenon Made?

In almost all cases, RP can be diagnosed when the doctor elicits a careful description of the symptoms -- especially of the characteristic color changes that occur in response to cold or stress.

The diagnosis of RP is certain if at least two (of the three) characteristic color changes occur. The diagnosis is considered probable when one characteristic color change is seen.

Provocative testing (that is, trying to induce an attack by exposing the hands to cold) used to be recommended, but is now discouraged. This is because RP tends to occur erratically, and cannot be readily reproduced at will.

How Is Raynaud Phenomenon Treated?

The mainstay of treatment is prevention. Sudden exposure to the cold should be avoided. When going out into the cold, keeping the entire body warm by wearing proper clothing is important. People who have frequent or severe RP should wear heated gloves or mittens, in preference to regular gloves.

Once an attack begins, it often can be aborted by warming the hands (for instance, by placing them under the armpits, or waving the arms around to stimulate circulation).

Avoiding tobacco products is particularly important in people with RP, since nicotine causes the blood vessels to constrict more readily. Avoiding medications that cause constriction of the blood vessels can also be quite important, including decongestants containing phenylephrine or pseudoephedrine.

In people whose attacks of RP follow emotional stress, stress reduction techniques can be quite helpful in reducing symptoms.

If preventive measures are inadequate to control symptoms, and especially if symptoms are severe, drug treatment is often useful. Several classes of drugs, aimed at preventing blood vessel constriction, have been used with some success. Calcium channel blockers have been the most effective drugs for RP, but other medications that dilate the blood vessels -- including nitroglycerin, hydralazine, and minoxidil -- have also been useful.

If RP is secondary to an underlying medical disorder, then treating that underlying disorder is critical to controlling attacks.

Fortunately, by using some combination of these measures, most people who have RP can control their symptoms sufficiently to lead essentially normal lives.


Wigley FM. Clinical practice. Raynaud's Phenomenon. N Engl J Med 2002; 347:1001.

Carpentier PH, Satger B, Poensin D, Maricq HR. Incidence and natural history of Raynaud phenomenon: A long-term follow-up (14 years) of a random sample from the general population. J Vasc Surg 2006; 44:1023.

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