Raynaud’s Phenomenon

Why it causes cold hands and feet.

What is Raynaud’s phenomenon?

Raynaud’s phenomenon is when your body overreacts to cold temperatures.

Normally, your body decreases blood flow to your fingers and toes in cold temperatures. But people with Raynaud’s phenomenon are much more sensitive to cold and their body overdoes the response. The same response can be triggered by stressful situations.

Raynaud’s causes fingers and/or toes to feel cold and turn white or blue (or both). If you warm the affected areas during an “attack,” it often goes away after 15 to 20 minutes.

Raynaud’s may occur without a known cause. This is known as primary Raynaud’s and usually affects younger women.

Secondary Raynaud’s is due to another medical condition or from a medication you’re taking.

What is causing your symptoms?

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Most common symptoms

Dr. Rx

Symptoms I listen for when diagnosing this illness: “I am afraid to go to the cold section of the supermarket." “Stress makes it worse.” “I am terrified of winters.” —Dr. Petros Efthmiou, MD, FACR

Your fingers and/or toes will turn white and/or blue when exposed to cold temperatures. Or if you’re experiencing an emotionally stressful event. Stressors can also decrease blood flow.

It happens even with mild exposure to cold, like when opening a refrigerator. Or after a mild emotional response like being startled.

During an attack, you may notice “pins and needles” or numbness in your hands, feet, fingers, and/or toes. Those areas can turn red as the blood returns.

Symptoms of Raynaud’s may seem similar to symptoms of nerve damage (peripheral neuropathy), for example, in people with diabetes. If you still have your sense of touch and can feel sharp objects, then you probably have Raynaud’s phenomenon—as opposed to peripheral neuropathy.

Main symptoms

Other symptoms you may have

  • Ears, nose, face, knees, and/or nipples may also turn white or blue in response to cold or emotional stress.
  • The skin on arms and legs may turn blue and/or purple. It may resemble bruises.
  • Can cause clumsiness in your hand, feet, fingers, or toes.
  • Color changes may not be symmetrical—start in one finger, then spread to other fingers. This is more common in secondary Raynaud’s.
  • If the Raynaud’s worsens over time, you may develop ulcers (sores) on the tips of your fingers and/or toes. This is more likely with secondary Raynaud’s.

What causes Raynaud’s phenomenon?

Normally, when you’re exposed to cold, blood vessels get narrower (constrict) to decrease blood flow to your hands and feet.

In Raynaud’s, blood vessels in the hands and feet overreact, stopping the blood flowing to your fingers and toes. Your fingers and toes then turn white. Eventually, they may turn blue from lack of oxygen.

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Types of Raynaud’s

There are two types of Raynaud’s—primary and secondary. Risk factors are different for each one.

Primary Raynaud’s

  • Women are far more likely to have primary.
  • Usually diagnosed between ages 15 and 30.
  • Living in a colder climate.

Secondary Raynaud’s

  • Some diseases can cause it (called secondary Raynaud’s). These include conditions that affect your immune system, blood, blood vessels, hormones, or neurologic system. These autoimmune conditions—where your body attacks itself—are the most common causes of secondary Raynaud’s:
    • Lupus
    • Scleroderma
    • Sjogren’s syndrome
    • Dermatomyositis
  • Older than 40 years old.
  • People diagnosed at an older age are more likely to be male.

Treatment for Raynaud’s phenomenon

Pro Tip

Ask your doctor: What are the chances that Raynaud’s is associated with an underlying autoimmune disease? And should I undergo capillaroscopy? —Dr. Efthmiou

Warm up your entire body—especially your hands and feet. Place them in warm water or put your hands in a warm place like your armpits. If you don’t see improvement within half an hour, go to urgent care or the ER.

Primary Raynaud’s generally causes more mild symptoms and doesn’t progress. Medications are used only if you continue to have attacks. In some cases, you may be referred to a rheumatologist.

For secondary Raynaud’s, the goal is to treat the underlying disease that’s causing the Raynaud’s symptoms.

For serious cases, like when ulcers develop on your fingers and/or toes, you may be referred to a hand surgeon for nerve surgery. Though this is very uncommon.

Your doctor may also inject a numbing medication (lidocaine) or nerve-blocking agent (Botox) into the affected fingers and/or toes.

How serious is Raynaud’s phenomenon?

Typically, Raynaud’s phenomenon is not serious. If you notice symptoms, see your doctor for an evaluation.

If symptoms (color changes, aching fingers/toes) don’t improve after you warm your body, hands, or feet, go to urgent care or an ER. It may be a sign of a more serious issue that’s affecting your blood circulation.

Pro Tip

A common misconception is that someone with Raynaud’s will develop lupus or scleroderma. —Dr. Efthmiou

Prevention

You can’t prevent Raynaud’s phenomenon, but you can try to reduce how often you have flare-ups.

  • Avoid changing from hot to cold environments quickly. For example, frozen-food sections of grocery stores or reaching into your freezer.
  • When you know you’re going to be exposed to cold weather, dress warmly, and wear gloves or mittens, and socks.
  • Stop smoking. The nicotine constricts blood vessels.
  • Try to reduce stress and practice ways of reducing your stress level such as deep breathing.
  • Some medications cause blood vessels to constrict and should be avoided if possible. They include cold medications (decongestants), diet pills, and migraine medications containing ergotamines or stimulants (caffeine).
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