Raynaud Syndrome: It’s Not Just Cold Fingers and Toes

Spend enough time outside in chilly weather—or inside in frigid air conditioning—and you may experience cold fingertips or toes. They might even turn blue.

If this just happens occasionally, and the color of the fingers and toes quickly returns to normal upon rewarming, you likely need warmer mittens or socks. But if the fingers and toes turn white accompanied by considerable pain, a condition called Raynaud phenomenon—sometimes called Raynaud syndrome or Raynaud’s disease—could be at play.

Raynaud (pronounced RAY-no) phenomenon, which is named after the French physician who discovered it, is a condition where small blood vessels overreact to cold temperatures by spasming and constricting, temporarily reducing blood flow. Repeated cycles of these vascular changes can damage tiny blood vessels leading to changes in the skin at the fingertips (dry, cracking, splitting skin), painful digital sores/ulcerations, and in extreme cases, gangrene (tissue death from loss of blood supply).

At first, the affected areas may appear blue because of decreased oxygen, then turn white as the skin tissue uses up the remaining oxygen, and finally, the skin turns red once the vessels dilate and the blood rushes back. The white and red color changes are typically when pain can occur.

“This is the classic presentation, but not everybody experiences all three colors, and the order of the color changes can vary,” says Monique Hinchcliff, MD, MS, a Yale Medicine rheumatologist. “But it’s important to note it’s not just your fingers turning cold with a bluish tinge with cold exposure, which is normal. The color changes must be marked.”

These episodes or “attacks” can last anywhere from a few minutes up to a few hours, depending on the severity of the episode and how quickly the affected area is warmed and blood flow is restored. Raynaud phenomenon most commonly involves the fingers and toes, but it can also occur in the nose, tip of the tongue, nipples, and tip of the penis. “It’s basically anywhere you have small blood vessels,” Dr. Hinchcliff explains.

When it occurs in the fingers, it is usually more than one finger but not necessarily all of them. It also usually affects someone’s dominant hand, though it can occur in the nondominant hand or in both hands at the same time. For most people, Raynaud phenomenon is not serious and can be easily managed by avoiding cold and stress and through simple lifestyle adjustments.

Blood flow in the skin is carefully controlled by signals from nerves, hormones, and other blood proteins. When someone feels stressed or anxious, the body releases chemicals that make blood vessels tighten, which can trigger an attack. More women—especially teens through age 30 roughly—experience Raynaud than men, which suggests that estrogen may play a role in the phenomenon.

There are two types of Raynaud phenomenon: primary and secondary. With primary Raynaud, which is the most common and affects up to 10% of the population, there is no underlying related disease.

“It’s harmless and just annoying,” Dr. Hinchcliff says. “People with this type don’t have a risk of digital ulcers forming and it doesn’t necessarily even need to be treated.”

Secondary Raynaud, however, is much less common and can be more severe than the primary form. Autoimmune diseases such as scleroderma, lupus, and polymyositis are often associated with Raynaud phenomenon. The condition can also develop in people whose jobs involve frequent use of vibrating machinery (like jackhammers or chainsaws), which over time can harm small blood vessels.

When Raynaud phenomenon is severe, the episodes of reduced blood flow may last longer and become more frequent. If circulation is restricted enough, ulcers can develop on the skin or, in rare instances, even lead to tissue damage or loss. Though it’s uncommon, some patients may have recurrent sores that are slow to heal and may develop scarring.

If your fingers or toes occasionally get cold and turn blue when exposed to cold temperatures, that is likely just your body’s response to big temperature changes, Dr. Hinchcliff explains.

“But if it's happening consistently and with white color changes, that could be Raynaud,” she says.

To diagnose Raynaud phenomenon, doctors can perform nailfold capillaroscopy, which allows them to look at the vessels at the skin surface below the fingernails with a microscope.

“These are the tiniest vessels in our bodies and they can be viewed quite easily. And if those are completely normal and there's no evidence of small hemorrhages or other signs, the patient is diagnosed with primary Raynaud,” Dr. Hinchcliff explains. “But if the capillary exam is abnormal or there's positive anti-nuclear antibodies identified, which we do from a blood test, then that suggests that there may be an underlying autoimmune disease. And that would be when a patient would want to see a rheumatologist.”

There are no medications approved by the U.S. Food and Drug Administration for the condition, but several are used off-label for Raynaud phenomenon, including calcium channel blockers and angiotensin receptor blockers, which relax blood vessels to improve blood flow to the fingers and toes; and erectile dysfunction drugs because they also dilate blood vessels.

For advanced cases that don’t respond to other treatments, Yale Medicine offers intravenous infusions of a medication called epoprostenol. This medication is a synthetic prostaglandin, a substance that our bodies naturally produce to cause blood vessel dilation. The infusions are offered at Yale outpatient centers throughout the state.

For people with primary Raynaud phenomenon, Dr. Hinchcliff suggests avoiding things that can trigger attacks, like extreme temperature changes and stress. Additionally, some migraine medications (like triptans), stimulants for attention-deficit hyperactivity disorder (methylphenidate or amphetamines), and heart medications (beta blockers) can exacerbate Raynaud symptoms.

“If you have Raynaud, you should talk to your primary care provider to optimize any medications you may be taking for other conditions,” she says.

Dr. Hinchcliff also recommends avoiding too much caffeine as it can narrow blood vessels, as can nicotine (from cigarettes or vaping). Of course, cocaine, a potent vasoconstrictor, should not be used by anyone, especially those with Raynaud phenomenon.

If you do have a Raynaud attack, Dr. Hinchcliff suggests simple steps to warm up whatever part of your body is affected. For example, if your hands are cold, place them in your armpits or sit on them, or run them under warm water, rather than very hot water as a more gradual warming is better for the body.

“You are trying to very slowly help the blood vessels relax, which will help avoid any pain,” Dr. Hinchcliff says. “If you are out in the cold, you can move your fingers and toes around to boost circulation, and hanging your arms down is good as gravity helps. Friction, like rubbing your hands together, is another idea. None of these things are a cure, but they can decrease the duration of attacks and lessen their severity.”

She also suggests keeping your core warm and considering heated gloves and vests or the charcoal heat packs you can put in gloves or mittens. Plus, it’s not just a condition for winter or cold-weather climates.

“Often, Raynaud is most problematic in places with a lot of air conditioning. And it seems to be going from one temperature to another. For example, if it's hot outside, and then you go into the grocery store where it's freezing, that can trigger an attack,” she says. “I always counsel patients to have a sweater and a pair of gloves on hand for these instances.”

For stress reduction, she suggests mindfulness exercises. “An ounce of prevention can be a pound of cure,” she says.