Raynaud's phenomenon (Raynaud's)
In the cold the fingers turn white and go numb, then turn blue, and as they warm up they flush red, tingle and hurt.
On this page
Medicines commonly prescribed for Raynaud's phenomenon (Raynaud's)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 5 mgActive substance: amlodipineManufacturer: Sandoz Farmaceutica S.A.Prescription requiredDosage form: TABLET, 10 mgActive substance: amlodipineManufacturer: Laboratorios Cinfa S.A.Prescription requiredDosage form: TABLET, 5 mgActive substance: amlodipineManufacturer: Teva Pharma S.L.U.Prescription required
In the cold the fingers turn white and go numb, then turn blue, and as they warm up they flush red, tingle and hurt. That is Raynaud's phenomenon, and several people in every hundred have it. For most it is a quirk of the blood vessels that people live with for decades and that never comes to anything. For a minority there is another illness behind it, and that one must not be missed. The difference does not show in the attack itself but in the details around it, which is what most of this page is about.
What an attack looks like
The small vessels in the fingers clamp down harder than they need to for a while, and blood almost stops reaching them. The classic attack runs in three stages: first the finger goes abruptly white, waxy, with a sharp border; then it turns bluish; and when the circulation returns it flushes red, warms up, tingles and aches. Not everyone goes through all three — often it stops at the blanching and the flush afterwards.
A few things worth knowing about it:
- an attack lasts from a few minutes to an hour or two, rarely longer;
- fingers are affected most often, but toes can be too, and sometimes the tip of the nose, the ears, the lips and the nipples — the last of these is especially noticeable when breastfeeding;
- it takes less than a frost to set it off: reaching into the freezer, stepping in from the street into air conditioning or picking up a cold can will do it;
- the other common trigger is worry and stress, with no cold involved at all;
- the pain usually comes not while the finger is white but as it warms back up.
The attack itself destroys nothing: a vessel closed and opened again. That is exactly why most people with Raynaud's need neither repeated investigations nor continuous treatment.
Primary Raynaud's — the harmless kind
When there is no other illness behind the attacks, it is called primary Raynaud's. This is the commonest form and it is recognised by a set of reassuring features: it starts in the teens or twenties, more often in women, and a mother or a sister frequently has the same thing. The fingers of both hands behave alike, they look and feel normal between attacks, the skin does not change, and no sores appear on the fingertips.
This kind of Raynaud's does not turn into something sinister over the years and does not end in losing a finger. It stays an inconvenience, and how big an inconvenience depends on the climate and the job: some people notice it twice a winter, others have to rearrange their daily routine around it. In some people the attacks soften with age.
Investigation here comes down to an examination and a few blood tests to confirm there really is nothing behind it. If they find nothing, there is no need to repeat them every year.
What white, numb fingers can be mistaken for
Not every colour change and not every numbness is Raynaud's. Several other things look similar.
- Chilblains. After a spell of real cold, itchy reddish-purple swellings come up on fingers and toes, bother you most as you warm up and last for days. A Raynaud's attack is short and leaves no swelling.
- Numbness from pressure. You slept on your arm: the pins and needles pass in minutes and the colour of the fingers does not change.
- Overbreathing with anxiety. It gives tingling in the fingers and around the mouth and trembling hands, but again with no blanching.
- Permanently blue hands. If the hands are cold and bluish all the time, with no clear attacks and no white phase, it is probably not Raynaud's.
- Trapped nerves. Numbness at night, in particular fingers, with a weakening grip — that is a nerve problem, not a vessel one.
Signs that something else may lie behind it
Secondary Raynaud's means the same attacks, but as a feature of another disease. What should prompt a closer look is not one sign on its own but a combination:
- the attacks began after the age of forty, or conversely in early childhood;
- they are not symmetrical — one hand, or particular fingers, suffers noticeably more;
- the thumbs are involved, which in the primary form they usually are not;
- ulcers or cracks appear on the fingertips and are slow to heal, or there are small pitted scars from earlier ones;
- the skin of the fingers has become tight and shiny and is hard to pinch up, and the fingers look puffy and swollen in the morning;
- persistent dryness of the eyes and mouth has appeared;
- swallowing is difficult, food seems to stick, and heartburn troubles you at night;
- painful, swollen joints, a rash on the face or hands, muscle weakness or unexplained breathlessness have joined in;
- the attacks have become heavier and longer over a short period.
Behind such a combination there is most often systemic sclerosis, lupus, Sjögren's syndrome, an inflammatory muscle disease or rheumatoid arthritis; in systemic sclerosis Raynaud's is quite often the very first symptom, years ahead of everything else. There are also causes that are not autoimmune: years of working with vibrating tools, damaged vessels in older smokers, and medicines. Among the medicines the ones usually named are beta blockers, migraine treatments, stimulants, some chemotherapy drugs and over-the-counter decongestant drops and tablets. If the attacks started soon after a new prescription, tell your doctor — but do not stop the medicine yourself.
When waiting is not an option
An ordinary attack, however unpleasant, is not urgent. The following, though, cannot be left "until the spring":
- an ulcer or sore on a fingertip that will not heal — that is no longer spasm but a shortage of blood supply;
- a finger that is darkening, turning black, or has developed a black scab;
- a finger that stays white or blue longer than usual and does not warm up at all;
- severe, constant pain in a finger that does not ease once it is warm;
- redness, swelling or pus around a sore — an infection has set in.
All of this means the tissue of the finger is now suffering continuously rather than in bursts, and time is working against you: the sooner treatment starts, the better the chance of keeping the finger intact. See a doctor within days, and with a blackening, badly painful finger, straight away.
What helps day to day
The main rule sounds counter-intuitive: warm the whole of you, not the hands. Finger vessels close down in response to the body cooling overall, so a warm coat and a hat do more for your fingers than the thickest gloves worn over light clothing.
- Mittens work better than gloves because the fingers warm each other. Thin liner gloves under mittens and reusable pocket warmers are useful too.
- Avoid sudden swings: in hot weather do not linger under the air conditioning, put gloves on to rummage in the freezer, and pick up a cold can through a napkin.
- An attack is easiest to stop early: tuck your hands under your arms, swing your arms in circles, hold your hands in lukewarm — not hot — water. Hot water speeds nothing up and scalds skin that cannot feel anything yet.
- Smoking narrows the vessels and clearly makes things worse: of everything within your control, stopping does the most.
- Coffee, tea and energy drinks do not affect everyone the same way — watch your own pattern before giving them up.
- Regular movement improves circulation, and steady breathing or whatever else settles you reduces attacks brought on by stress.
- Look after the skin of your hands: dry, cracked skin heals badly. Use a cream, do not walk around in wet gloves, and do not cut your nails too short.
- If you work with vibrating tools, raise it both with your doctor and at work — what matters is not just protection but cutting down the time of exposure.
What a doctor can do
The first job is to work out whether the Raynaud's is primary or secondary. For that a doctor asks about everything listed above, examines the skin and joints, and may arrange blood tests for inflammation and autoantibodies. One examination deserves a mention of its own: looking at the capillaries at the base of the nail under magnification. It is painless and shows, within minutes, the vessel changes typical of systemic disease.
If attacks are getting in the way of life, or ulcers have already appeared, medicines that widen the vessels are prescribed. The usual starting point is a calcium channel blocker — the same group used for high blood pressure. Some people take one every day, others only through the cold months. The choice is the doctor's: these drugs have their own side effects and combinations that do not suit.
When a systemic disease turns out to be behind the attacks, that disease is what gets treated first, and a rheumatologist takes it on. Fingertip ulcers that will not heal need more specialised care, sometimes in hospital — one more reason not to put off the appointment.
Online consultation
The main question is one that suits a remote appointment well: does what is happening to you look like ordinary primary Raynaud's, or are there features worth investigating. The doctor will ask what age it started, whether both hands behave the same, whether the thumbs are involved, whether there is dryness of the eyes and mouth or difficulty swallowing, and will go through your list of medicines — sometimes the cause is sitting right there.
It is also a good way to plan for winter and to weigh up whether treatment is worth discussing when attacks are interfering with work. What is not assessed online is a sore on a finger that will not heal, and still less a finger that is darkening: those need looking at in person, and soon.
This material is for information only and does not replace medical advice.
Consult with a doctor about Raynaud's phenomenon (Raynaud's)
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Raynaud's phenomenon (Raynaud's)
Discuss your symptoms and possible next steps for Raynaud's phenomenon (Raynaud's) with a doctor online.
