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Raynaud's phenomenon

Published by Bupa's health information team, November 2008.

This factsheet is for people who have Raynaud's phenomenon, or those who would like information about it.

Raynaud's phenomenon - sometimes called Raynaud's disease, Raynaud's syndrome or just Raynaud's - is a common condition that affects the blood supply to your hands and feet.

Raynaud's phenomenon causes extremities to turn white, blue or red and to go numb or to hurt. It's brought on by the cold or emotional stress.

About Raynaud's phenomenon
Symptoms
Complications
Causes
Treatment
Further information
Questions and answers
Sources

About Raynaud's phenomenon

Raynaud's phenomenon was first described by the French doctor Maurice Raynaud in 1862. It affects between five and 10 percent of western populations at any time. It's more common among women than men.

There are two types of Raynaud's phenomenon: primary Raynaud's and secondary Raynaud's. In primary Raynaud's, no one knows the exact cause. Secondary Raynaud's is caused by another condition.

Symptoms

Usually, Raynaud's phenomenon is mild and doesn't occur very often. An episode generally lasts a few minutes.

Raynaud's phenomenon affects the extremities (eg fingers or toes). It tends to affect fingers and thumbs more often than toes. On rare occasions it can affect your nose, ears, lips, tongue or nipples.

During an attack the affected area will go pale and feel cold or numb. It may then turn blue and then finally red. As it turns red you will feel an aching or burning pain, or a tingling "pins and needles" sensation.

As the skin changes colours, a spectrum of colours may emerge, including purple, yellow, orange and grey.

Episodes of Raynaud's can be triggered by cold temperatures or emotion. Sometimes even a slight change in temperature can cause it, so staying warm is important. Even touching a cold surface such as a milk bottle or putting your hand in the fridge can be enough to trigger an episode.

Rarely, Raynaud's can be more serious, happening several times a day or for long periods.

Complications

It's very unusual for Raynaud's phenomenon to be serious, especially if you have primary Raynaud's. Rarely it can cause problems such as ulcers on a finger or even gangrene if the attack is prolonged and severe.

Causes

Primary Raynaud's phenomenon

An episode of primary Raynaud's phenomenon happens when the small arteries (arterioles) supplying blood to an extremity narrow. This reduces the blood supply, making it go pale.

The extremity will sometimes turn blue because deoxygenated blood (which has a bluish tinge) pools there. The redness is caused when the arteries start to widen (dilate) and fresh, oxygenated blood flows back in.

No one knows exactly why some people have primary Raynaud's phenomenon and others don't. However, it may be because of an exaggerated response of the body to cold.

Secondary Raynaud's phenomenon

Secondary Raynaud's phenomenon is when the Raynaud's episode is due to another underlying reason. There are many possible causes of secondary Raynaud's. Some examples are listed below.

Connective tissue diseases such as systemic lupus erythematosus, systemic vasculitis and scleroderma.
Neurological disorders in which you can't use some or all of your limbs, or which affect other parts of your nervous system.
Some medicines, such as beta blockers, anti-migraine medication, and the contraceptive pill can cause secondary Raynaud's phenomenon as a side effect.
Occupational exposure. Exposure of your extremities to vibration can induce Raynaud's phenomenon. This can happen when using pneumatic drills or chainsaws, or when holding materials that are being hammered or shaken. This is called vibration white finger. It can occur both in the hand holding the tool, or the other hand.

Secondary Raynaud's tends to be more severe than primary Raynaud's phenomenon.

Treatment

What treatment you receive for Raynaud's phenomenon depends on what type you have. If you have secondary Raynaud's, your doctor will first try to treat the underlying cause. If you're taking a medicine that is causing it, he or she may stop you taking them and try to find an alternative treatment.

If you have a very severe attack of Raynaud's, you may be admitted to hospital, where you will be given medicines to help increase the blood supply to your extremities and prevent any blood clots forming.

Non-surgical treatment

Medicines

Usually you don't need to take medicines to treat primary Raynaud's. If it's regularly affecting your work or social life, your GP may prescribe you nifedipine. This is a type of medicine called a calcium channel blocker. It works by relaxing the muscles in your blood vessels so that more blood can reach your extremities.

Other types of medicines are sometimes used to treat Raynaud's phenomenon if nifedipine isn't helping or if you can't take it. Some examples are listed below.

Angiotensin-converting enzyme (ACE) inhibitors (eg captopril or analapril). These work by blocking the effect of angiostensin, which causes blood vessels to constrict.
Peripheral vasodilators (eg inositol nicotinate). These also dilate blood vessels, and are sometimes used for treating Raynaud's.
Other types of medicines such as selective serotonin reuptake inhibitors are also sometimes used.

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Self-help

Raynaud's phenomenon can usually be helped by making a few changes to your lifestyle. For example:

keep your whole body warm, not just your hands and feet
use a portable heater at home, especially in winter
keep hats, gloves and socks in your airing cupboard or on a radiator, so that they are not cold when you put them on
don't expose your hands to the cold - for example use a towel or glove to cover them when taking things out of the freezer
soak your hands or feet in warm water soon after an episode starts - make sure that it isn't too hot or cold first
don't smoke - smoking is very bad for the blood circulation
keep active - regular movement and not sitting down for long periods will help to improve your blood circulation and reduce symptoms
manage your stress - learning relaxation techniques might help Raynaud's in people who have episodes brought on by stress
exercising regularly may also help

Counselling

Your doctor may recommend counselling for stress if your Raynaud's is triggered by anxiety.

Alternative therapies

Some people claim dietary supplements can help Raynaud's syndrome. However, there is little evidence to show that they are useful in treating Raynaud's. Some examples of supplements that people have used include:

Vitamin C
Vitamin E
Omega-3 oils
Evening primrose oil
Ginko biloba

Talk to your GP about whether these supplements are suitable for you.

Surgery

Usually there is no need for any surgery for Raynaud's phenomenon. However, if it is very serious, and regularly risks causing serious damage to the parts of the body where blood supply is cut off, surgery is sometimes carried out. This involves cutting the nerves that cause blood vessels to narrow in a part of the body (sympathetic nerves).

In the fingers, this surgery is called a digital sympathectomy. It is sometimes used if only one finger is affected.

If the legs or feet are severely affected, a lumbar sympathectomy may be performed. The operation involves cutting nerves in the back that control blood vessel narrowing in the legs.

Cervical sympathectomy, which involves cutting the sympathetic nerves that control the blood supply of the arm at a point in the neck, is not effective. It only gives short-term benefits.

Further information

Raynaud's & scleroderma association
01270 872 776
www.raynauds.org.uk