Understanding Raynaud's Syndrome: Symptoms, Causes, and Treatments

Raynaud’s is named after a French doctor, Maurice Raynaud, who first described the condition in 1862. Raynaud’s syndrome was later studied by Sir Thomas Lewis in 1930. 

Raynaud’s phenomenon, also called Raynaud’s disease or Raynaud’s syndrome, is a rare disease that occurs due to reduced blood flow in affected body parts, most commonly the fingers or toes, in response to cold temperatures or emotional stress. Other parts of the body that can be affected by Raynaud’s syndrome include the ears, nose, lips, and nipples. 

Raynaud’s symptoms occur because of a temporary vasospasm in the skin that causes arterioles and capillaries (tiny blood vessels) to narrow.

Primary Raynaud’s Syndrome vs. Secondary Raynaud’s Syndrome

Raynaud’s occurs in primary or secondary form. The primary form is the more common type. Primary Raynaud’s disease occurs by itself for unclear reasons and is not linked to other health conditions. 

Secondary Raynaud phenomenon is associated with an underlying disease or other risk factors such as:

• Autoimmune and connective tissue diseases such as scleroderma, CREST syndrome, systemic lupus erythematosus, antiphospholipid syndrome, Sjogren’s syndrome, and rheumatoid arthritis

• Other medical conditions such as fibromyalgia, arteriovenous fistula, polycythemia, myalgic encephalitis, malignancies, and certain musculoskeletal and skin diseases

• Other diseases, such as pulmonary hypertension, a type of high blood pressure in the lungs

• Occupational exposure to vibrating machinery, ammunition, chemicals such as polyvinyl chloride, and cold injuries such as frostbite at work

• Carpal tunnel syndrome and repetitive movements, such as typing on a keyboard, playing the piano, or using vibrating tools

• Obstructive vascular disease and blood disorders, such as microemboli, diabetic angiopathy, thromboangiitis obliterans, or atherosclerosis, especially in people over 60 years of age 

• Injuries to the hands or feet, such as frostbite, fractures, or surgery.

• Certain infections such as cytomegalovirus, parvovirus B19, hepatitis B, and hepatitis C 

• Certain medications, including antimigraine drugs, beta-blockers for high blood pressure, some cold medications, drugs used to treat attention deficit hyperactivity disorder (ADHD), certain cancer medicines, immunosuppressants such as cyclosporine

Who Gets Raynaud’s Phenomenon?

Raynaud disease is 9 times more common in women than men. It particularly affects young women in their teens and 20s. This disorder also seems to be more common in people who live in cold climates.

Raynaud Syndrome Symptoms

Common Symptoms

Primary Raynaud phenomenon typically causes milder symptoms that can be managed with lifestyle changes. The symptoms sometimes go away on their own without treatment. Common symptoms include:

• Cold and numb fingers or toes.

• Pale or white skin, which then turns blue (these color changes may be harder to see in darker skin tones).

• Pins and needles, a throbbing or prickly feeling, swelling, or stinging pain when the affected area is warmed, or stress is relieved.

Secondary Raynaud’s syndrome can sometimes cause more severe symptoms, including skin ulcers (painful sores) or gangrene (dead tissue) due to poor blood flow or a completely blocked artery.

How to Identify Raynaud's 

An attack can be triggered by exposure to cold temperatures, such as washing your hands in cold water, taking something out of the freezer, or being outdoors in cold weather. Sometimes, emotional stress or anxiety can trigger a Raynaud’s episode.

During Raynaud's attacks, the affected areas first turn pale, then turn blue, and feel cold and numb. As the skin warms or emotional stress is relieved, blood flow returns to the areas, causing them to change color again, tingle, throb, swell, or be painful. An attack can last about 15 minutes.

What is the Root Cause of Raynaud's Disease?

Researchers have not identified the root cause of Raynaud's attacks. It appears that in people with this condition, the blood vessels in the hands and feet overreact to cold temperatures or stress, causing them to narrow. This limits blood flow to the area, causing Raynaud’s symptoms. With time, the small blood vessels can thicken, further restricting blood flow and making the symptoms worse. 

Risk Factors for Primary Raynaud’s Syndrome

• Female gender

• Age between 15 and 30

• Living in a cold climate

• Family history of Raynaud’s in a close relative (parent, sibling, or child)

Risk Factors for Secondary Raynaud’s Syndrome

• Certain diseases, such as scleroderma and lupus

• Certain occupations that involve the use of vibrating tools or repetitive movements

• Exposure to certain substances, such as tobacco smoke or vinyl chloride 

• Certain medications

Can Raynaud's Turn Into Lupus?

About 1 in 10 people with primary Raynaud’s disease go on to develop autoimmune disorders such as lupus. Secondary Raynaud’s disease is frequently associated with autoimmune diseases, including lupus, in which the body’s immune system mistakenly attacks healthy tissues.

How is Raynaud's Syndrome Diagnosed?

There is no single test that can be used to definitively diagnose Raynaud’s phenomenon. Your healthcare provider can make a diagnosis of Raynaud’s disease based on your symptoms, medical history, physical exam, and tests such as:

• Nailfold capillaroscopy to find out if it is the primary or secondary form.

• Blood tests, such as antinuclear antibody (ANA) and erythrocyte sedimentation rate (ESR), to diagnose connective tissue diseases and autoimmune diseases that could cause Raynaud’s syndrome.

• Other blood tests to rule out diseases of the blood vessels.

How is Raynaud's Phenomenon Treated?

Mild Raynaud’s symptoms can be treated with lifestyle changes such as wearing thick gloves and socks. More severe symptoms may need to be treated with medications by a healthcare provider, such as:

• Dihydropyridine calcium channel blockers, such as amlodipine (Norvasc), felodipine, nifedipine (Procardia), and isradipine. These drugs are vasodilators - they help to relax and open up blood vessels in the hands and feet. They can also promote the healing of skin ulcers. 

• Other drugs, such as: 

  • Losartan (Cozaar): an angiotensin receptor blocker (ARB) used to treat hypertension

  • Sildenafil (Viagra, Revatio): a phosphodiesterase type-5 (PDE-5) inhibitor used to treat erectile dysfunction or pulmonary hypertension

  • Bosentan (Tracleer): a medicine prescribed for pulmonary hypertension

  • Fluoxetine (Prozac): an SSRI antidepressant medication

  • Topical nitroglycerin

Treatments for Worsening Symptoms of Raynaud’s Disease

• Chemical injections: Drugs such as onabotulinumtoxinA (Botox) can temporarily block the nerves in affected areas. Repeat shots are necessary if symptoms return. 

• Sympathectomy nerve surgery: A neurosurgeon can cut nerves in the hands and feet that regulate the opening and closing of small blood vessels in the skin. If successful, this surgery can reduce the frequency and duration of Raynaud’s episodes. 

Tips for Managing Raynaud’s Symptoms

• Go indoors if you are outside in the cold.

• Warm the affected areas by wiggling the affected fingers or toes, placing your hands in your armpits, making wide circles with your arms, massaging the affected fingers or toes, or running warm water over your hands and feet.

• Practice stress-relieving techniques, such as deep breathing, if stress has triggered a Raynaud’s disease episode.

Long-Term Strategies for Managing Raynaud Phenomenon

The following steps can help to decrease the frequency and severity of Raynaud's episodes: 

• Avoid going quickly from hot to cold temperatures.

• Quit smoking if you smoke. Also, avoid exposure to second-hand smoke. Chemicals in cigarette smoke damage blood vessels, cause them to tighten, and trigger a drop in skin temperature.

• Get regular exercise to improve blood flow. However, talk to your healthcare provider before exercising outdoors in cold weather.

• Manage stress through exercise, meditation, yoga, mindfulness, and deep breathing. Anxiety and stress are triggers for Raynaud's symptoms in some people. 

Natural Remedies for Raynaud’s Disease

Certain dietary supplements, such as fish oil supplements and ginkgo biloba, may improve blood flow and help in managing Raynaud’s disease. You can also talk to your healthcare provider about alternative treatments such as biofeedback and acupuncture. 

Prevention of Raynaud’s Phenomenon

To prevent Raynaud's attacks:

• Stay warm when outdoors by wearing a hat, scarf, earmuffs, face mask, two sets of gloves or mittens, a coat with cuffs, thermal underwear, thick socks, and boots to protect from cold air. 

• Set your thermostat to a warmer temperature. 

• Keep warm indoors by wearing socks and mittens during the daytime and to bed in the winter months. 

• Wear gloves, mittens, or oven mitts when taking food out of the refrigerator or freezer. 

• Use drinking glasses with handles to keep your hands from getting cold.

• Run the heater in your car for a few minutes before driving in cold weather.

FAQs and Additional Resources

What is the Life Expectancy of Someone with Raynaud's Syndrome?

People with Raynaud’s disease have a normal life expectancy. It is not a serious illness, but it can affect your quality of life and be difficult to live with. In severe cases, complications such as skin sores or gangrene can occur. However, severe Raynaud’s is rare, and most cases can be managed with lifestyle changes and medications.

What Foods Should You Avoid with Raynaud's Syndrome?

You should avoid caffeine as it can decrease blood circulation in the fingers and toes. Also, be careful while handling cold drinks and frozen foods, as this can trigger episodes of Raynaud’s disease. 

Support and Resources

The Raynaud’s Association is a non-profit organization that provides support to people living with Raynaud phenomenon, including tips for coping with daily activities.