Raynaud's phenomenon is a condition in which blood flow to the skin is restricted in response to cold or emotional stress, and it primarily affects the fingers and toes. It can be classified as primary, without an underlying cause, or secondary, due to complications from another condition.
What is Raynaud’s phenomenon?
In response to exposure to the cold, the body restricts blood flow to the skin to preserve its core temperature. People with Raynaud’s phenomenon (also called Raynaud’s syndrome) experience this restriction of blood flow more readily because of an enhanced sensitivity to cold. The areas of the body affected are typically the fingers and toes, although in rare cases Raynaud’s can affect the lips, nose, ear lobes, nipples, or tongue.[1] The restriction of blood flow in people with Raynaud’s is also commonly triggered by emotional stress. Raynaud’s can be categorized as primary (without another underlying cause) or secondary (resulting from complications of another condition).[2][3][4]
What are the main signs and symptoms of Raynaud’s phenomenon?
Raynaud’s phenomenon occurs when flares or “attacks” trigger blood vessels in certain parts of the body to constrict, reducing blood flow and causing pain, numbness, and tingling. The fingers and toes are the most common areas affected, but Raynaud’s can also affect the nose and ears.
During a Raynaud’s attack, loss of blood flow to the affected area causes the tissue to turn a pale white color. As blood in the area loses oxygen, the tissue becomes blue and feels cold and numb. When circulation is restored, the affected areas turn red and become swollen. People may also experience a tingling, burning, or throbbing sensation at this stage. Attacks can last from minutes to hours, but in rare cases Raynaud’s attacks can last for days, causing permanent damage to the affected areas.[1][2]
Severe attacks, which are more common with secondary Raynaud’s phenomenon, can cause ulcers or sores to form on the end of the affected fingers or toes.
How is Raynaud’s phenomenon diagnosed?
When Raynaud’s is suspected, a health care provider will consider risk factors such as the age of onset and location of the affected areas on the body and will evaluate the overall frequency and severity of symptoms. The person’s health history will also be reviewed for the presence of other symptoms that may indicate secondary Raynaud’s caused by another underlying condition.[2]
A technique called nailfold capillary microscopy (NCM) may also be used to differentiate between primary and secondary Raynaud’s. NCM allows the physician to see changes in the structure of the capillaries that may indicate the presence of underlying conditions implicated in secondary Raynaud’s, such as scleroderma or other connective tissue disorders.[5][6][7]
What are some of the main medical treatments for Raynaud’s phenomenon?
The main medical treatments for Raynaud’s are focused on reducing the severity and frequency of attacks and improving blood flow. Early treatments for Raynaud’s typically involve conservative therapies focused on lifestyle changes to avoid the circumstances that trigger attacks. This can include limiting cold exposure, avoiding stimulants such as caffeine[8] or ADHD medications such as Ritalin (methylphenidate)[9], and managing stress.
If conservative treatments fail, the following medications may be used to treat blood vessel constriction:
Have any supplements been studied for Raynaud’s phenomenon?
Several supplements have been studied for Raynaud’s phenomenon.
-
Pycnogenol: In a pilot trial comparing pycnogenol supplementation + standard therapy to standard therapy alone in women with primary Raynaud’s, pycnogenol supplementation significantly improved blood flow and reduced symptoms. Pycnogenol also improved tissue oxygen levels and reduced levels of biomarkers for oxidative stress.[15]
-
Fish oil: Fish oil was shown in one study to improve cold tolerance and delay blood vessel constriction in people with Raynaud’s.[16]
-
Essential fatty acids (omega-3 and omega-6): In a cohort of healthy participants, daily supplementation with an essential fatty acid (EFA) supplement for 6 months reduced red blood cell aggregation. Since red blood cell aggregation has been implicated in worsening blood flow to the affected extremities in people with secondary Raynaud’s, the authors speculated that EFA supplements and/or fish oil might be useful for treating Raynaud’s.[17]
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Beetroot juice: Beetroot juice improved blood flow and blood vessel function and reduced inflammation in people with Raynaud’s.[18]
Additional supplements studied for treating Raynaud’s include L-arginine and N-acetylcystine (NAC). However, neither L-arginine[19][20] nor NAC[21] supplementation were found to improve blood flow in people with Raynaud’s.
How could diet affect Raynaud’s phenomenon?
There haven’t been many studies specifically testing the effect of diets on Raynaud’s. However, some investigators have speculated that foods with circulation-improving properties such as garlic[22] may help to improve blood flow. Additionally, foods that contain caffeine should be avoided, because it decreases blood flow to the extremities.[23]
Are there any other treatments for Raynaud’s phenomenon?
Some alternative, nonpharmaceutical interventions have been used to treat Raynaud’s, including exercise, therapeutic gloves, and laser therapy.[24][25]
Acupuncture has also shown some modest benefits, although it remains to be seen whether it can cause a meaningful reduction in symptoms.[26]
An older study found that immersing the hand in warm water then exposing it to cold increased finger temperatures in people with Raynaud’s,[27] possibly through training the body’s natural ability to constrict and dilate blood vessels in response to environmental conditions.
What causes Raynaud’s phenomenon?
The most common cause of Raynaud’s phenomenon is overactivation of the sympathetic nervous system. This causes an increased release of the neurotransmitter norepinephrine, which binds to and activates adrenergic receptors. When the alpha-2 adrenergic receptors on blood vessels are activated, the smooth muscle tissue that lines the blood vessel walls contracts, causing vasoconstriction (a narrowing of blood vessels).
Excessive blood vessel constriction reduces blood flow to the extremities, which causes the characteristic changes in skin color associated with Raynaud’s as well as pain, tingling, and numbness.
There are two main variants of Raynaud’s: primary and secondary. With primary Raynaud’s, the disorder occurs on its own, independent of any underlying condition. In contrast, secondary Raynaud’s is caused by the presence of another underlying condition, such as lupus, scleroderma, or other autoimmune disorders.[2]
Examine Database: Raynaud's Phenomenon
Frequently asked questions
What is Raynaud’s phenomenon?
In response to exposure to the cold, the body restricts blood flow to the skin to preserve its core temperature. People with Raynaud’s phenomenon (also called Raynaud’s syndrome) experience this restriction of blood flow more readily because of an enhanced sensitivity to cold. The areas of the body affected are typically the fingers and toes, although in rare cases Raynaud’s can affect the lips, nose, ear lobes, nipples, or tongue.[1] The restriction of blood flow in people with Raynaud’s is also commonly triggered by emotional stress. Raynaud’s can be categorized as primary (without another underlying cause) or secondary (resulting from complications of another condition).[2][3][4]
What are the main signs and symptoms of Raynaud’s phenomenon?
Raynaud's phenomenon is characterized by episodes in which blood vessels constrict, which lead to reduced blood flow and symptoms such as pain, numbness, and tingling, primarily in the fingers and toes. During an attack, the affected areas may turn pale, blue, and then red as circulation returns, and severe cases can result in ulcers or sores.
Raynaud’s phenomenon occurs when flares or “attacks” trigger blood vessels in certain parts of the body to constrict, reducing blood flow and causing pain, numbness, and tingling. The fingers and toes are the most common areas affected, but Raynaud’s can also affect the nose and ears.
During a Raynaud’s attack, loss of blood flow to the affected area causes the tissue to turn a pale white color. As blood in the area loses oxygen, the tissue becomes blue and feels cold and numb. When circulation is restored, the affected areas turn red and become swollen. People may also experience a tingling, burning, or throbbing sensation at this stage. Attacks can last from minutes to hours, but in rare cases Raynaud’s attacks can last for days, causing permanent damage to the affected areas.[1][2]
Severe attacks, which are more common with secondary Raynaud’s phenomenon, can cause ulcers or sores to form on the end of the affected fingers or toes.
What are the early signs of a Raynaud’s attack?
Quick answer:
A Raynaud’s attack usually begins in one finger and can spread to other fingers on both hands, whereas the thumb is generally not affected. If the thumb is involved, it may suggest secondary Raynaud’s phenomenon.
A Raynaud’s attack typically starts at a single digit such as a finger and then spreads to additional fingers on both hands. The thumb isn’t typically affected, but if it is, this can be an indicator of secondary Raynaud’s phenomenon.[2]
What medical complications are associated with Raynaud’s phenomenon?
Quick answer:
Raynaud's phenomenon can lead to ulcers on the fingers or toes due to prolonged blood vessel constriction and reduced blood flow. If untreated, this condition may result in necrosis and gangrene, which could necessitate amputation.
Because of prolonged blood vessel constriction and reduced blood flow, ulcers can form on the tips of fingers or toes from the tissue damage. If left untreated, this can potentially lead to necrosis (a form of tissue death) and gangrene, potentially requiring amputation of the affected area.[2]
Which type(s) of physicians treat Raynaud’s phenomenon?
Quick answer:
Primary care physicians can treat primary Raynaud's phenomenon, but rheumatologists should be consulted for suspected secondary cases. In severe, treatment-resistant cases, a vascular surgeon may perform a sympathectomy to address the condition.
A primary care physician can treat primary Raynaud’s phenomenon. A rheumatologist should be consulted in cases of suspected secondary Raynaud’s phenomenon. In severe cases that are resistant to other forms of treatment, a vascular surgeon may perform a sympathectomy, which is a surgical procedure to destroy the nerves causing the affected blood vessels to narrow.[2][28]
How is Raynaud’s phenomenon diagnosed?
Raynaud's phenomenon is diagnosed by evaluating risk factors and symptom frequency/severity and reviewing the individual's health history for signs of secondary Raynaud's. Additionally, nailfold capillary microscopy may be used to identify structural changes in capillaries that suggest underlying conditions.
When Raynaud’s is suspected, a health care provider will consider risk factors such as the age of onset and location of the affected areas on the body and will evaluate the overall frequency and severity of symptoms. The person’s health history will also be reviewed for the presence of other symptoms that may indicate secondary Raynaud’s caused by another underlying condition.[2]
A technique called nailfold capillary microscopy (NCM) may also be used to differentiate between primary and secondary Raynaud’s. NCM allows the physician to see changes in the structure of the capillaries that may indicate the presence of underlying conditions implicated in secondary Raynaud’s, such as scleroderma or other connective tissue disorders.[5][6][7]
What are some of the main medical treatments for Raynaud’s phenomenon?
The main medical treatments for Raynaud's phenomenon aim to reduce the severity and frequency of attacks while improving blood flow, starting with conservative lifestyle changes. If these are ineffective, medications such as alpha-receptor blockers, phosphodiesterase inhibitors, calcium-channel blockers, endothelin-1 inhibitors, and selective serotonin reuptake inhibitors (SSRIs) may be prescribed.
The main medical treatments for Raynaud’s are focused on reducing the severity and frequency of attacks and improving blood flow. Early treatments for Raynaud’s typically involve conservative therapies focused on lifestyle changes to avoid the circumstances that trigger attacks. This can include limiting cold exposure, avoiding stimulants such as caffeine[8] or ADHD medications such as Ritalin (methylphenidate)[9], and managing stress.
If conservative treatments fail, the following medications may be used to treat blood vessel constriction:
What is the prognosis for Raynaud’s phenomenon? Can it be cured with treatment?
Quick answer:
There is no cure for Raynaud's phenomenon, and treatment focuses on managing lifestyle triggers and using prescription drugs to reduce blood vessel constriction. In cases of primary Raynaud's, the condition may resolve spontaneously without treatment.
There are currently no treatments available that can cure Raynaud’s. The treatments are focused on limiting the lifestyle factors that can trigger an attack and/or suppressing the constriction of blood vessels with prescription drugs. However, in people with primary Raynaud’s, the disorder may spontaneously resolve on its own.[2]
When should I seek medical treatment for Raynaud’s phenomenon?
Quick answer:
Seek medical treatment for Raynaud's phenomenon if severe or frequent attacks occur that affect daily life, if sores or ulcers develop, or if there is a diagnosis of secondary Raynaud's because these conditions can lead to serious complications like tissue damage or gangrene. Timely intervention is crucial to manage symptoms and prevent permanent harm.
You should consult with your healthcare provider for Raynaud’s under the following conditions:
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Reduced quality of life: You should seek medical treatment for Raynaud’s if you experience severe or frequent attacks that affect your quality of life and/or ability to carry out daily tasks. Because Raynaud’s mostly affects the hands, severe attacks can make it difficult to type or grasp objects.
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Tissue damage: It is also important to get medical treatment if sores or ulcers form after a Raynaud’s attack to avoid permanent scarring and damage.
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Secondary Raynaud’s diagnosis: Getting treatment for the underlying conditions that trigger secondary Raynaud’s, such as an autoimmune disorder, is critical for managing symptoms and avoiding complications. Secondary Raynaud’s attacks can be more severe than primary Raynaud’s, increasing the likelihood of permanent tissue damage and scarring. In severe cases of secondary Raynaud’s, extended attacks can cause tissue death and potentially gangrene, a condition that occurs when tissue dies from a prolonged lack of blood supply. Gangrene is a potentially life-threatening condition which may require amputation of the affected part of the body.[29][2]
Have any supplements been studied for Raynaud’s phenomenon?
Several supplements have been studied for Raynaud's phenomenon — including pycnogenol, fish oil, essential fatty acids, and beetroot juice — and have shown improvements in blood flow and symptoms. However, L-arginine and N-acetylcystine did not demonstrate benefits in enhancing blood flow for individuals with Raynaud's.
Several supplements have been studied for Raynaud’s phenomenon.
-
Pycnogenol: In a pilot trial comparing pycnogenol supplementation + standard therapy to standard therapy alone in women with primary Raynaud’s, pycnogenol supplementation significantly improved blood flow and reduced symptoms. Pycnogenol also improved tissue oxygen levels and reduced levels of biomarkers for oxidative stress.[15]
-
Fish oil: Fish oil was shown in one study to improve cold tolerance and delay blood vessel constriction in people with Raynaud’s.[16]
-
Essential fatty acids (omega-3 and omega-6): In a cohort of healthy participants, daily supplementation with an essential fatty acid (EFA) supplement for 6 months reduced red blood cell aggregation. Since red blood cell aggregation has been implicated in worsening blood flow to the affected extremities in people with secondary Raynaud’s, the authors speculated that EFA supplements and/or fish oil might be useful for treating Raynaud’s.[17]
-
Beetroot juice: Beetroot juice improved blood flow and blood vessel function and reduced inflammation in people with Raynaud’s.[18]
Additional supplements studied for treating Raynaud’s include L-arginine and N-acetylcystine (NAC). However, neither L-arginine[19][20] nor NAC[21] supplementation were found to improve blood flow in people with Raynaud’s.
How could diet affect Raynaud’s phenomenon?
There is limited research on the effect of diet on Raynaud's phenomenon, but some studies suggest that circulation-improving foods like garlic may enhance blood flow. Conversely, it is recommended to avoid caffeine-containing foods because they can reduce blood flow to the extremities.
There haven’t been many studies specifically testing the effect of diets on Raynaud’s. However, some investigators have speculated that foods with circulation-improving properties such as garlic[22] may help to improve blood flow. Additionally, foods that contain caffeine should be avoided, because it decreases blood flow to the extremities.[23]
Are there any other treatments for Raynaud’s phenomenon?
Alternative treatments for Raynaud's phenomenon include nonpharmaceutical interventions such as exercise, therapeutic gloves, laser therapy, and acupuncture, which may provide modest benefits. Additionally, a study suggested that alternating between warm water immersion and cold exposure could help increase finger temperatures by training the body's vascular responses.
Some alternative, nonpharmaceutical interventions have been used to treat Raynaud’s, including exercise, therapeutic gloves, and laser therapy.[24][25]
Acupuncture has also shown some modest benefits, although it remains to be seen whether it can cause a meaningful reduction in symptoms.[26]
An older study found that immersing the hand in warm water then exposing it to cold increased finger temperatures in people with Raynaud’s,[27] possibly through training the body’s natural ability to constrict and dilate blood vessels in response to environmental conditions.
What causes Raynaud’s phenomenon?
Raynaud's phenomenon is primarily caused by overactivation of the sympathetic nervous system; it leads to increased norepinephrine release and subsequent vasoconstriction, which reduces blood flow to the extremities. There are 2 variants: primary Raynaud's occurs independently, and secondary Raynaud's is associated with underlying conditions like lupus or scleroderma.
The most common cause of Raynaud’s phenomenon is overactivation of the sympathetic nervous system. This causes an increased release of the neurotransmitter norepinephrine, which binds to and activates adrenergic receptors. When the alpha-2 adrenergic receptors on blood vessels are activated, the smooth muscle tissue that lines the blood vessel walls contracts, causing vasoconstriction (a narrowing of blood vessels).
Excessive blood vessel constriction reduces blood flow to the extremities, which causes the characteristic changes in skin color associated with Raynaud’s as well as pain, tingling, and numbness.
There are two main variants of Raynaud’s: primary and secondary. With primary Raynaud’s, the disorder occurs on its own, independent of any underlying condition. In contrast, secondary Raynaud’s is caused by the presence of another underlying condition, such as lupus, scleroderma, or other autoimmune disorders.[2]
What conditions cause secondary Raynaud’s phenomenon?
Quick answer:
Secondary Raynaud's phenomenon can be caused by various conditions, including autoimmune disorders (like lupus and scleroderma), certain medications, occupational exposures, obstructive vascular diseases, and infectious diseases. Additionally, it has been associated with other conditions such as fibromyalgia, cancer, and polycythemia.
The following conditions have been implicated in the development of secondary Raynaud’s:
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Autoimmune conditions: Autoimmune disorders such as systemic lupus erythematosus, antiphospholipid syndrome, scleroderma, and Sjogren syndrome can trigger Raynaud’s attacks.[30][31][2]
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Medications: Certain medications such as beta blockers, cyclosporine, and migraine medications have been linked to secondary Raynaud’s.[2]
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Occupational exposure: Exposure to vibrations from machinery, chemicals from PVC, and chemicals associated with ammunition production can trigger Raynaud’s attacks.[2]
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Obstructive vascular diseases: Diseases that block or reduce blood flow through blood vessels such as atherosclerosis and diabetic angiopathy (a condition that causes blood flow restriction from high glucose levels) can cause secondary Raynaud's.[2]
-
Infectious diseases: Infections such as hepatitis B, hepatitis C, and cytomegalovirus[2] can cause secondary Reynaud’s.
Secondary Raynaud’s has also been linked to other conditions such as fibromyalgia, cancer, and polycythemia (a blood condition associated with abnormally high red blood cell production).[2]
What populations are most at-risk for developing Raynaud’s phenomenon?
Quick answer:
Younger women, particularly those in their teens to 30s, are at the highest risk for developing Raynaud's phenomenon. The condition is significantly more common in women than in men, with a ratio of 9:1.
Younger women (teenaged through age 20–30) tend to be at the highest risk for developing Raynaud’s. Raynaud’s is more common among women than men, with a 9:1 female-to-male ratio.[32]
What are the mechanisms that cause tissue damage from Raynaud’s attacks?
Quick answer:
Tissue damage from Raynaud's attacks primarily occurs after blood vessels reopen, which leads to a rapid influx of oxygenated blood that causes ischemia-reperfusion injury and generates reactive oxygen species. This triggers an inflammatory response that results in pain, swelling, and potentially severe complications like blood clots or ulcers.
Although counterintuitive, much of the pain and potential tissue damage associated with the latter stages of a Raynaud’s attack occur after the constricted blood vessels have opened back up, which causes a rapid influx of oxygenated blood into the previously hypoxic (low oxygen) tissue. This triggers a type of ischemia-reperfusion injury, generating high levels of reactive oxygen species that are damaging to the tissue. In response to the damage, the immune system is mobilized, causing immune cells to move into the area and secrete high levels of pro-inflammatory cytokines. The characteristic deep-red and swollen appearance of the affected digits, as well as the pain and throbbing sensations, are caused by the inflammatory response. In extreme cases, the latter phase of Raynaud’s attacks can lead to the formation of blood clots, ulcers, or sores in the affected areas.[33]
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References
Examine Database References
- Raynaud's Phenomenon Symptoms - Bredie SJ, Jong MCNo significant effect of ginkgo biloba special extract EGb 761 in the treatment of primary Raynaud phenomenon: a randomized controlled trialJ Cardiovasc Pharmacol.(2012 Mar)
- Raynaud's Phenomenon Symptoms - Choi WS, Choi CJ, Kim KS, Lee JH, Song CH, Chung JH, Ock SM, Lee JB, Kim CMTo compare the efficacy and safety of nifedipine sustained release with Ginkgo biloba extract to treat patients with primary Raynaud's phenomenon in South Korea; Korean Raynaud study (KOARA study)Clin Rheumatol.(2009 May)
- Raynaud's Phenomenon Symptoms - DiGiacomo RA, Kremer JM, Shah DMFish-oil dietary supplementation in patients with Raynaud's phenomenon: a double-blind, controlled, prospective study.Am J Med.(1989 Feb)
- Raynaud's Phenomenon Symptoms - Zhou F, Huang E, Zheng E, Deng JThe use of acupuncture in patients with Raynaud's syndrome: a systematic review and meta-analysis of randomized controlled trials.Acupunct Med.(2023 Apr)
- Endothelial Function - Shepherd AI, Costello JT, Bailey SJ, Bishop N, Wadley AJ, Young-Min S, Gilchrist M, Mayes H, White D, Gorczynski P, Saynor ZL, Massey H, Eglin CM"Beet" the cold: beetroot juice supplementation improves peripheral blood flow, endothelial function, and anti-inflammatory status in individuals with Raynaud's phenomenon.J Appl Physiol (1985).(2019 Nov 1)