Raynaud’s Syndrome

What is Raynaud’s syndrome?

Raynaud’s (pronounced ray-nodes) syndrome is a disorder that affects small blood vessels in your fingers and toes. It may also affect blood vessels in your nose, lips or ear lobes. Raynaud’s causes you to have episodic spasms, called vasospastic attacks, in response to cold temperatures or stress.

During a Raynaud’s attack, the arterioles and capillaries in your fingers and toes tighten more than they should. As a result, your skin in the affected area turns white and then blue. This color change happens because your blood lacks oxygen. Your skin may also feel cold or numb. As your blood vessels relax and open up again, your skin may look red or feel tingly. An attack usually lasts around 15 minutes.

What are the different types of Raynaud’s syndrome?

There are two main types of Raynaud’s syndrome:

• Primary Raynaud’s syndrome (also called Raynaud’s disease).
• Secondary Raynaud’s syndrome (also called Raynaud’s phenomenon).

The chart below lists what you should know about each type.

What is the difference between Raynaud’s disease, Raynaud’s phenomenon and Raynaud’s syndrome?

Most people use these terms interchangeably. But scientists use them to distinguish between primary and secondary forms of the condition.

• Raynaud’s disease: Occurs on its own and isn’t connected with another disease or condition. This is also called primary Raynaud’s syndrome.
• Raynaud’s phenomenon: Occurs due to an underlying condition, medication or lifestyle factor. This is also called secondary Raynaud’s syndrome.
• Raynaud’s syndrome: Refers to either the primary or secondary form of the condition.

Is Raynaud’s syndrome serious?

Primary Raynaud’s syndrome isn’t serious and doesn’t damage your blood vessels. It may disrupt some of your daily activities, but it’s not dangerous.

Secondary Raynaud’s syndrome can be more serious. It may lead to skin ulcers and, rarely, tissue death (gangrene). It may also impact your quality of life. The underlying disease causing it may be severe in and of itself.

Who does Raynaud’s syndrome affect?

Primary Raynaud’s syndrome usually affects:

• People assigned female at birth.
• People under age 30, often starting in the teenage years.
• People who have a family history of Raynaud’s disease.

Secondary Raynaud’s syndrome usually affects people who have another disease or condition. It can also affect people who perform a job that puts repetitive pressure on their hands. Here are some facts to know:

• About 9 in 10 people with scleroderma have Raynaud’s phenomenon. This may be the only scleroderma symptom they have for many years.
• About 1 in 3 people with lupus have Raynaud’s phenomenon.
• People with autoimmune conditions, especially connective tissue diseases, are at higher risk of Raynaud’s.
• People who use hand tools that vibrate (such as jackhammers or chain saws) face a higher risk of Raynaud’s phenomenon. The condition is also more common in pianists and keyboard operators.

How common is Raynaud’s syndrome?

Raynaud’s syndrome is common. Estimates vary, but Raynaud’s likely affects up to 1 in 20 people in the U.S.

How does Raynaud’s syndrome affect my body?

Raynaud’s syndrome is an exaggerated version of a normal body process called vasomotor response. Vasomotor response means your blood vessels open up (vasodilation) and tighten (vasoconstriction) to help your body respond to its environment.

For example, if it’s cold outside, blood vessels near your skin’s surface constrict to move blood to veins deeper in your body. This allows your body to conserve heat. Your blood vessels also constrict when you’re stressed to help your body save oxygen.

Raynaud’s disrupts this normal body process and causes your blood vessels to constrict more than they should. This interrupts your normal blood flow and limits the oxygen available to your fingers or toes.

How does Raynaud’s disease affect my heart?

Primary Raynaud’s syndrome doesn’t affect your heart. But conditions associated with secondary Raynaud’s syndrome may affect your heart. Talk with your healthcare provider to learn if your condition affects your heart.

What are the symptoms of Raynaud’s syndrome?

Raynaud’s symptoms affect your skin and may include:

• Color changes. As blood flow stops and then returns, your skin color may change from white to blue to red. Some people don’t experience all three changes in skin color.
• Feeling cold or numb. This happens when your finger or other affected body part isn’t receiving oxygen-rich blood. It feels like that part of your body has “fallen asleep.”
• Feeling warmth, tingling or throbbing: This happens as blood flow returns to your affected body part.
• Skin ulcers and gangrene: Longer or more frequent attacks may lead to painful sores on your fingertips. These sores can take a while to heal. Rarely, lack of oxygen to your tissues may lead to tissue death (gangrene).

Symptoms of Raynaud’s syndrome are episodic. That means they come and go. A typical episode, or attack, lasts about 15 minutes. But attacks may be shorter or longer. Episodes are often associated with certain triggers such as cold weather. Symptoms are usually mild in people with primary Raynaud’s syndrome. People with secondary Raynaud’s syndrome may have more severe symptoms, including skin ulcers.

Raynaud’s can cause your skin to change color briefly . It may first look white before turning blue then red. Your skin may also feel cold or numb at the start of an attack due to reduced blood flow. When blood flow returns, your fingers may feel warm or throb.

What triggers Raynaud’s disease?

Triggers that can lead to a Raynaud’s attack include:

• Air-conditioned rooms or other cold spaces like the frozen food aisle in a grocery store.
• Anxiety, emotional stress or excitement.
• Cold weather.
• Holding a glass of ice water or another cold drink.
• Reaching into the freezer.
• Sweat that cools on your skin.

What causes Raynaud’s syndrome?

Primary Raynaud’s syndrome has no identifiable underlying cause.

An underlying disease or condition usually causes secondary Raynaud’s syndrome (Raynaud’s phenomenon). It’s especially common in people with connective tissue diseases. Some of these diseases reduce blood flow to your fingers and toes.

Other causes include repetitive motions and some medications. The lists below break down the many causes of Raynaud’s phenomenon.

Diseases and conditions that can cause Raynaud’s phenomenon

• Buerger’s disease (especially in people assigned male at birth who smoke).
• Cancer.
• Carpal tunnel syndrome.
• Dermatomyositis.
• Hypothyroidism.
• Lupus.
• Mixed connective tissue disease.
• Peripheral artery disease (especially in people assigned male at birth over age 50).
• Polymyositis.
• Pulmonary hypertension.
• Rheumatoid arthritis.
• Scleroderma and CREST syndrome.
• Sjögren’s syndrome.
• Thoracic outlet syndrome.
• Vasculitis.

Medications and substances that can cause Raynaud’s phenomenon

• Beta-blockers.
• Caffeine.
• Chemotherapy (bleomycin, vinblastine).
• Cocaine.
• Decongestants containing phenylephrine or pseudoephedrine.
• Epoxy resins.
• Migraine medications containing ergotamine.
• Nicotine.
• Stimulant medications (like methylphenidate) that treat attention-deficit/hyperactivity disorder (ADHD).

Other causes of Raynaud’s phenomenon

• Frostbite.
• Traumatic vasospasm from vibrating tools or repeated pounding with the palm of your hand. This can include playing a piano.

How is Raynaud’s syndrome diagnosed?

Healthcare providers can typically diagnose Raynaud’s syndrome from your symptoms. Your provider may ask you to take photos of your skin changes when they happen. Your provider may also perform a physical exam and talk with you about your medical and family history.

Raynaud’s syndrome is usually easy to diagnose. But it may not be obvious whether you have the primary or secondary form. That’s where diagnostic testing can help.

What tests diagnose Raynaud’s syndrome?

Several diagnostic tests can help determine if you have primary or secondary Raynaud’s syndrome.

One test that’s particularly useful is a nailfold capillaroscopy. For this test, your provider places a drop of oil on your skin at the base of your fingernail. This spot is called your nailfold. Your provider then looks at your nailfold under a microscope. If your capillaries in the area are enlarged or abnormal, you may have a connective tissue disease. This would indicate you likely have secondary Raynaud’s syndrome.

Other tests your provider may order include:

• Antinuclear antibody (ANA) test: Blood test that checks for autoimmune diseases.
• Complete blood count (CBC): Blood test that checks for a range of conditions.
• Erythrocyte sedimentation rate (ESR) test: Blood test that detects inflammation in your body. Helps diagnose rheumatoid and autoimmune disorders, among other conditions.
• Urinalysis: Urine test that checks for a range of conditions.
• Pulse volume recording: Noninvasive test that checks blood flow in your arms and legs.
• Rheumatoid factor (RF) test: Blood test that checks for autoimmune diseases.

These tests can help your provider identify or rule out underlying conditions as causes of your Raynaud’s symptoms.

Who treats Raynaud’s syndrome?

You may receive care from healthcare providers in different specialties. That’s because Raynaud’s syndrome can affect your body in many ways. It can also result from a wide range of medical conditions. Providers who may help with your diagnosis and treatment include:

• Cardiologists.
• Dermatologists.
• Primary care physicians.
• Rheumatologists.

What is the treatment for Raynaud’s syndrome?

Treatment depends on the severity of your condition and whether you have the primary or secondary form. Treatment goals include:

• Prevent Raynaud’s attacks.
• Help reduce the severity of attacks.
• Improve your quality of life.
• Treat the underlying disease or condition (if you have secondary Raynaud’s).
• Prevent skin ulcers and tissue damage.

For many people, lifestyle changes are enough to manage their condition. These include:

• Avoid cold spaces (like the frozen food aisle or extreme air conditioning).
• Avoid touching cold objects (like glasses of ice water or cold metal surfaces).
• Manage stress and strong emotions that could trigger an attack.
• Wear warm clothes during cold weather.

However, if you have severe symptoms, you may need medication. Your provider may prescribe one or more of the following medications:

• Calcium-channel blockers: These drugs help your smallest blood vessels relax and open up. As a result, you have fewer attacks, and those you do have are less severe. Calcium-channel blockers also can help heal skin ulcers on your fingers or toes.
• Alpha-blockers: These drugs counteract norepinephrine. That’s a hormone that constricts your blood vessels.
• Nitroglycerin skin ointment: This is a cream that you apply to your fingers to help heal skin ulcers.

If you have severe Raynaud’s and other treatment methods don’t work, your provider may recommend a procedure called a sympathectomy. A sympathectomy temporarily blocks or cuts tiny nerves near your affected blood vessels. This prevents the nerves from sending signals that make your blood vessels get too narrow. The procedure should relieve your symptoms for one or two years, but you may need it again in the future.

How can I prevent Raynaud’s syndrome?

There’s nothing you can do to prevent Raynaud’s syndrome. But you can help prevent attacks by learning your triggers and taking action to avoid them.

It’s also important to visit your provider for yearly checkups. Doing so can help your provider diagnose and treat underlying conditions that may cause Raynaud’s phenomenon. Some of these conditions are preventable with lifestyle changes, such as avoiding tobacco products.

What can I expect if I have Raynaud’s syndrome?

For most people with primary Raynaud’s syndrome, the outlook is positive. Symptoms may bother you off and on, but the condition isn’t serious or life-threatening. Over time, you’ll learn more self-care tips for preventing attacks or helping them go away.

If you have secondary Raynaud’s syndrome, your outlook depends on your underlying disease. Talk with your provider about what you can expect and how to manage your condition.

How do I take care of myself?

Self-care is essential for managing Raynaud’s syndrome. Follow your healthcare provider’s guidance on how to avoid triggers and how to manage an attack when it happens. The following tips can also help.

How to avoid Raynaud’s triggers

• Adjust your thermostat so your home or office is warm.
• Avoid caffeine.
• Avoid touching cold metals or putting your hands in cold water.
• Bring a jacket or sweater if you know a space will be cold.
• Don’t go barefoot. Wear socks indoors, and wear two pairs of socks when going outside in the cold.
• Exercise regularly to improve your overall well-being. Check with your provider before starting a new exercise plan.
• Keep your feet and hands dry and warm. Consider using a disposable or rechargeable hand warmer.
• Keep your whole body warm, but especially your hands, feet and head. Wear several layers of loose clothing. Don’t forget mittens (warmer than gloves) and a hat.
• Learn new ways to manage stress in your life.
• Limit use of tools (like jackhammers) that vibrate.
• Limit your time in air conditioning and in cold spaces (like the frozen foods aisle).
• Practice good skin care. Apply lotion to prevent dry or cracked skin.
• Quit smoking (or don’t start). Nicotine causes your skin temperature to drop, which may trigger an attack. Talk to your healthcare provider about ways to help quit smoking.
• Take frequent breaks during the day to rub your hands together.
• Use a beverage holder or insulating sleeve to hold cold drinks.
• Wear oven mitts when you reach into your fridge or freezer.
• Wear wicking fabrics when you exercise to move sweat away from your skin.

Also, it’s important to know which medications can trigger an attack. Ask your provider if any of your current medications could cause your condition to flare up. These include some medications that treat:

• ADHD.
• Cancer.
• Colds and nasal congestion.
• High blood pressure.
• Certain heart medicines.
• Migraines.

How to manage a Raynaud’s attack

If an attack does happen, be proactive. Don’t ignore a Raynaud’s attack or assume it’ll go away on its own. Taking the proper steps can reduce the length and severity of an attack. Here’s what to do:

• Immediately go to a warmer space.
• Massage the affected area.
• Move your arms in circles.
• Put your hands under your armpits to warm them up.
• Run warm (not hot) water over your fingers or toes.
• Meditate or do deep breathing exercises if stress triggered your attack.

When should I see my healthcare provider?

Call your provider if you:

• Have attacks that occur on just one side of your body.
• Have sores or ulcers on your fingers or toes.
• Lose function in the affected hand or foot.
• Notice new or worsening symptoms.
• Experience side effects from medications.

As with any condition, see your provider any time you’re worried, frightened or have questions about how to care for yourself.

How can I help my child manage Raynaud’s syndrome?

Primary Raynaud’s disease often begins during the teenage years. Rarely, it can begin earlier. So, if your child or teen starts to have symptoms, take them to see their healthcare provider. Their provider may want to run tests to rule out an underlying condition.

Usually, Raynaud’s in kids and teens is mild, and symptoms should ease as your child gets older. The same management tips for adults also can help your child. For example, dress your child warmly in cold weather (and give them two pairs of mittens to wear rather than just one). Keep your home and car warm, and avoid air conditioning that’s too cold.

It’s also important to tell administrators at your child’s school about their condition. Your child may need special permission to avoid outdoor activities (like gym class) during the colder months.

A note from Cleveland Clinic

Raynaud’s syndrome is a common condition that may affect your quality of life. Learning how to care for yourself at home can help you avoid and manage Raynaud’s attacks. If your symptoms are preventing you from doing the things you love, talk with your provider about treatment options. It may also help to connect with a support group to learn from others living with the same condition.