Raynaud's phenomenon (usually just called Raynaud's) is a common condition of the blood vessels that supply blood to the skin.  During a Raynaud's attack, the blood vessels narrow, reducing blood flow to the hands. This causes the fingers to become cold and white, with a feeling of pins and needles and numbness. The fingers eventually turn blue and then red, and they are sometimes painful.

Types of Raynaud's

There are two types of Raynaud's. It can either be:

• primary - the most common form of the condition, where there is no apparent cause, or
• secondary - where the condition is associated with another, underlying condition, such as rheumatoid arthritis (swelling and pain in the joints).

How common is Raynaud's?

In the UK, Raynaud's is thought to affect as many as 10 million people. However, it is difficult to determine an exact figure for the incidence of Raynaud's because many people with the condition are unaware that it has a name, or that it can be treated. Therefore, they do not go to see their GP about it. 
Raynaud's is much more common in women than it is in men. The condition can affect people of all ages, although it usually develops before a person is 40 years of age.

Outlook

The symptoms of Raynaud's are usually mild, and they do not tend to affect day-to-day life. Even in more severe cases of Raynaud's, the condition can usually be successfully managed with medication. Sometimes, the condition disappears without treatment.

Symptoms of Raynaud's depend on the length and severity of the attack. Primary Raynaud's tends to be fairly mild, whereas secondary Raynaud's, caused by another condition, is often more severe.

• In primary Raynaud's, all fingers on both hands are usually affected at once.
• In secondary Raynaud's, symptoms often begin in one or two fingers on one hand.

The first signs of a Raynaud's attack are when the fingers turn white then bluish and feel cold and numb. This happens because, when the blood vessels narrow, the blood cannot get to the surface of the skin.

As circulation improves and blo

When your body is exposed to cold temperatures, your fingers and toes lose heat. This happens because the small blood vessels under the skin of your fingers and toes become narrower. This slows down the blood supply to these areas, which helps to preserve your body's core temperature.

In people with Raynaud's, the small blood vessels in the fingers and toes are more sensitive than usual and overreact to cold temperatures. This makes them narrow more than usual and allows a very limited amount of blood to flow through them.

Symptoms can be triggered by even mildly cool weather, getting something out of the freezer or running your hands under a cold tap.

Strong emotion or anxiety may also trigger symptoms.

Primary Raynaud's

In most cases, the cause of Raynaud's is unknown. This is called primary Raynaud's. Some doctors think it may be inherited (runs in the family).

Secondary Raynaud's

In some cases, there is an underlying reason that causes the blood vessels to overreact. This is called secondary Raynaud's.

Health conditions

Various conditions of blood vessels, joints or skin can cause secondary Raynaud's, including:

• scleroderma (a condition that causes hardening and thickening of the skin),
• rheumatoid arthritis,
• Sjogren's syndrome (where the body attacks its own glands), and
• lupus.

Medicines

Secondary Raynaud's can be a side effect of taking certain medicines, including:

• anti-migraine medication,
• beta-blockers (used to treat raised blood pressure or heart disease),
• some cancer drugs,
• decongestants and, occasionally,
• the contraceptive pill and HRT.

Injury and overuse

Raynaud's sometimes results from a physical injury to the affected area. It can also affect musicians, typists or other people who use their fingers and hands more than usual.

Vibration

'Vibration white finger' is a term used when secondary Raynaud's has been caused by exposure to vibration. This typically happens to people who regularly use certain types of vibrating tools, including:

• concrete breakers and pokers,
• sanders, grinders and disc cutters,
• hammer drills,
• chipping hammers,
• chainsaws, hedge trimmers and power mowers, and
• scabblers and needle guns.

Any vibrating tool that causes tingling or numbness in your fingers after five minutes of continuous use could lead to vibration white finger.

Your employer has a responsibility to protect you from vibration white finger. You can help your employer by asking if the job could be done differently, without using vibrating tools. If this is not possible:

• ask to use suitable low-vibration tools,
• use the right tool for the job,
• check tools to make sure they are properly maintained,
• make sure cutting tools are kept sharp,
• reduce the amount of time you use the tool in one go by doing other jobs in between,
• keep warm at work,
• wear anti-vibration gloves and warm clothing if working in the cold,
• store tools correctly so they do not have cold handles when next used, and
• encourage your blood circulation by keeping warm, giving up smoking and massaging and exercising your fingers during your breaks.

If you are diagnosed with vibration white finger, tell your employer as soon as possible. If you stop exposure to vibration at an early stage of the condition, you may recover fully.

By law, your employer must contact the Health and Safety Executive about your condition. You may be entitled to an Industrial Injuries Disablement Benefit (see Useful links), a payment given to people who have become ill or injured as a result of their work. Contact your nearest Jobcentre Plus to see if you qualify.

odflow returns, the affected areas may turn red, throb, tingle or swell, causing pain. The order in which symptoms occur may not be the same for all people and not everyone's fingers turn all three colours.

An attack may last for less than a minute or several hours and, over time, attacks may grow more severe.

If you have secondary Raynaud's, you may also experience joint pain and swelling, and rashes.

If your GP suspects you have Raynaud's, they will ask for a description of your symptoms and examine you to rule out other causes, such as arthritis or scleroderma.

Raynaud's can often be diagnosed directly from a description of your symptoms, but it may be more difficult to identify if another condition is causing your symptoms (secondary Raynaud's).

Your GP may refer you to a dermatologist (skin specialist) or a rheumatologist (joint specialist) for further tests, outlined below.

Cold-simulation test

A cold-simulation test involves placing your hands in cool water or exposing you to cold air to bring on an episode of Raynaud's. This allows the specialist to witness your symptoms.

Nail fold capillaroscopy

To find out if your Raynaud's is primary or secondary, the doctor may perform a nail fold capillaroscopy. This involves an examination of the tiny blood vessels (capillaries) near your nail fold (the skin at the base of your fingernail) under a microscope.

Enlarged or deformed capillaries may indicate an underlying disease, although some secondary conditions cannot be spotted by this test.

Blood tests

There is no single blood test to diagnose Raynaud's, but your doctor may want to do a blood test if they suspect an underlying condition.

Antinuclear antibodies (ANA) test

This blood test checks for antinuclear antibodies in your blood. These antibodies are produced by your immune system by mistake and attack your body's own tissues.

If these antibodies are present, it indicates an overactive immune system, which is common in people with connective tissue diseases or other autoimmune disorders, such as rheumatoid arthritis and lupus (commonly associated with Raynaud's).

Erythrocyte sedimentation rate

This blood test measures how fast your red blood cells settle to the bottom of a test tube. A faster-than-normal fall rate suggests inflammation (swelling of the tissues), which can indicate an autoimmune disorder.

Self-care and preventative measures, such as keeping warm or quitting smoking, are usually all that is needed to control mild symptoms (see Self-help, above).

If self-care methods do not help or your symptoms are severe, your doctor may try one of the treatments outlined below.

Medication

Nifedipine

Nifedipine works by 'opening up' the small blood vessels and helping circulation. You have to take it daily to control symptoms. Some people only use it during the winter or cold weather spells.

Do not drink grapefruit juice when taking nifedipine. The juice can increase the amount of nifedipine absorbed by the body, which could cause changes in blood pressure.

Angiotensin blocking vasodilators

Angiotensin blocking vasodilators block the effects of angiotensin, which is the chemical produced by the body to make the blood vessels narrow.

Stress counselling

Counselling may be useful if you have primary Raynaud's and your symptoms are triggered by stress or anxiety.

Sympathectomy or 'nerve blocks'

Sympathectomy or 'nerve blocks' may be recommended if you have severe Raynaud's that is not helped by other treatments. This surgical treatment aims to stop the pain of a Raynaud's attack by cutting or stripping the nerves either to or in the affected area.

Intravenous infusion therapy

If your Raynaud's is severe and does not respond to the above treatments, your doctor may perform intravenous infusion therapy. This is the injection of drugs into the bloodstream through a vein, sometimes called a 'drip'.

This is usually given for three to five days using a drug called iloprost, which aims to open up (vasodilate) the blood vessels to help them carry more blood to all areas of the body.

Iloprost also helps reduce clotting (when blood clumps together) and may lower the number of harmful cells in damaged blood vessels.

If you have mild Raynaud's, the self-care techniques described below can help control your attacks.

Stop smoking

Smoking can make symptoms worse as the chemicals in tobacco can cause the small blood vessels to narrow. Quitting may ease or cure the problem.

Cut down on caffeine

Tea, coffee and cola can also worsen symptoms in some people. Try cutting out caffeine for a few weeks to see if it helps.

Keep warm

Wear warm gloves, socks and shoes when you are out in the cold weather. It is best to put on the gloves when you are warm, before going out into the cold.

If you have severe symptoms or your symptoms are easily triggered, portable heat packs and battery-heated gloves and socks can be useful. Speak to your GP or someone at your local pharmacy.

Although it is important to keep your hands and feet warm, your symptoms are less likely to occur if you keep your entire body warm. Wrap up in warm clothes, a hat and scarf when you are out in cold weather.

Put natural fibres, such as cotton, wool and silk, next to your skin. Man-made fibres tend to make your skin sweat, which cools you by conducting heat away from you body. Layers of clothes are good as they trap air, which is a good insulator.

Check your medication

Some medicines used to treat other conditions can trigger symptoms of Raynaud's or make them worse. However, do not stop a prescribed medicine if you suspect it may be making symptoms worse. See your doctor first to discuss the options.

Avoid touching cold objects

Sometimes, just touching something cold, like putting your hands under a cold tap or getting something out of the freezer, can bring on an attack. Try not to do the things that cause an attack.

Thrombosis and gangrene

In severe cases, the blood vessel walls may eventually get thicker and the flow of blood may be permanently reduced. Arteries may become blocked because of blood clotting (thrombosis), which can lead to tissue death (gangrene) at the tips of the affected fingers or toes.

Scleroderma

A small number of people who have Raynaud's also develop scleroderma, a disease that affects the connective tissue (the supporting tissues of the body, such as tendons and ligaments).

Scleroderma literally means 'hard skin', but it can also damage the internal organs and their blood supply.

Symptoms of scleroderma include:

• puffy and itchy skin,
• tight and uncomfortable joints,
• small calcium spots and red spots under the skin,
• trouble swallowing, and
• diarrhoea, bloating or constipation.

There is no cure for scleroderma, but there are ways of overcoming the problems it may cause.

Medicines can reverse or slow down the processes that cause damage around the body. They can also calm down the overactive immune system and improve blood circulation. As each person with scleroderma is affected in a different way, other treatments are used to treat problems if and when they occur.

It is important to have plenty of vitamins A, C, and E in your diet. These antioxidants help reduce inflammation. A healthy diet, not smoking and doing regular exercise are important to protect your heart.