Raynaud’s Phenomenon (RP) occurs when there is a decrease in the blood flow to the fingers and toes caused by a tightening of blood vessels due to cold weather exposure or stress. Other common areas of the body that can be affected by RP include the ears, nose, and nipples. There are two forms of RP, primary and secondary. The primary form has no known cause and primarily affects women under 30. The secondary form of RP stems from conditions, such as lupus, rheumatoid arthritis, and thyroid disease.¹

Signs and Symptoms

The signs of an RP attack include one or more fingers or toes turning white due to decreased blood flow, then turning blue from lack of tissue oxygenation. Following the attack, the skin will turn red as blood returns to the area. Symptoms can last from seconds to minutes; however, some attacks may persist for hours. Patients with severe RP are prone to ulcers on their fingers and toes from tissue death.¹ 

Diagnosing Raynaud’s

Rheumatologists primarily treat RP; cardiologists and primary care physicians also often diagnose and treat RP. In addition to taking medical history and performing an exam, providers may also conduct a nailfold capillary microscopy to inspect the bases of the fingernails. 

Risk Factors

Stress can trigger an attack, as the body’s response to anxiety causes blood vessels to narrow.² Nicotine users are at risk for attacks, as nicotine triggers narrowing of blood vessels, and long-term smoking can lead to permanent damage of blood vessels. Decongestants, weight-loss drugs, beta blockers, migraine medications, and stimulants can trigger RP attacks.²

Symptom Management

Individuals who experience RP can prevent attacks by wearing mittens, gloves, thick socks, and using hand and feet warmers. In warmer temperatures, experts advise against cold air conditioning as a means to mitigate episodes. Wear oven mitts when taking food out of the fridge or freezer. Exercise can help maintain healthy blood circulation and mitigate triggers.¹ When attacks occur, warm hands by running them under warm water, placing the affected area under a heating pad, and massaging hands/feet.^1,2

Calcium channel blockers and angiotensin-receptor blockers can help increase blood flow.¹ Surgery for severe RP might be a viable treatment option; a surgeon will perform incisions or injections to destroy the nerves responsible for triggering the narrowing of blood vessels in the affected areas. Repeated lack of tissue oxygenation as a result of frequent RP attacks may lead people to develop skin sores or gangrene, and this might require hospitalization to improve blood flow and treat these infections. Rarely patients require surgical removal of dead tissue.²

Sources

1. Shah B. Raynaud’s phenomenon. Rheumatology.org. Updated Feb 2023. https://rheumatology.org/patients/raynauds-phenomenon. Accessed 26 Mar 2024.
2. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Raynaud’s phenomenon. US Department of Health and Human Services. Reviewed May 2021. https://www.niams.nih.gov/health-topics/raynauds-phenomenon. Accessed 26 Mar 2024.