Raynaud's phenomenon: symptoms and treatment

NHS inform describes Raynaud's as a common condition that affects the blood supply to certain parts of the body, usually the fingers and toes. It is also called Raynaud's syndrome, Raynaud's disease or just Raynaud's. It is usually triggered by cold temperatures, anxiety or stress.

Body heat is conserved by narrowing the small vessels under the skin in the cold. In Raynaud's these vessels overreact and become narrower than usual, significantly restricting blood flow. NHS inform says symptoms can be triggered by mildly cool weather, getting something out of the freezer or running your hands under a cold tap, and that people often go for long periods without symptoms.

The NHS says that when you are cold, anxious or stressed your fingers and toes may change colour. The skin may turn white or paler as blood flow is restricted, sometimes blue, then red as blood flow returns. On brown or black skin it may make the fingertips look paler. Pain, numbness and pins and needles can accompany the changes.

Some people find their ears, nose, lips or nipples are affected as well. The NHS also helps tell it apart from other causes of hand symptoms: pins and needles from resting on a limb, hyperventilation without colour change, and chilblains, which cause burning or itchy swelling after being very cold and worsen as you warm up.

• White, then blue, then red colour changes in fingers or toes

• Numbness, pain or pins and needles during an attack

• Attacks triggered by cold, stress or anxiety

• Episodes lasting minutes to a few hours

• Occasionally affecting ears, nose, lips or nipples

Primary Raynaud's is the most common form and occurs without another health condition. NHS inform says it usually begins in the 20s or 30s, seems to involve disruptions in how the nervous system controls blood vessels, and may run in families. About 1 in 10 people with primary Raynaud's goes on to develop a condition associated with secondary Raynaud's.

Secondary Raynaud's is caused by something else and can start at any age. NHS inform lists autoimmune conditions including scleroderma, rheumatoid arthritis, Sjogren's disease and lupus; the blood-borne infections hepatitis B and C; some blood and immune system cancers; certain medicines; injury, frostbite and overuse; smoking; and vibrating tools.

The NHS advises seeing a GP if symptoms are very bad or getting worse, affecting daily life, only on one side of the body, accompanied by joint pain, skin rashes or muscle weakness, starting for the first time after age 30, or if a child under 12 has symptoms. NHS inform adds that secondary Raynaud's may be suspected if symptoms started after 30, severe pain occurs during attacks, or only one side is affected.

Seek prompt advice for any open sore on a fingertip or toe, because NHS inform says the initial sign of tissue damage in severe Raynaud's is an ulcer, and that left untreated tissue can die. This is rare and normally occurs only in secondary Raynaud's. A finger that stays pale, cold and numb, or becomes dark or very painful, needs urgent assessment.

NHS inform says Raynaud's can usually be diagnosed after an examination of your symptoms and some blood tests. A GP may place your hands in cold water or cool air to see if symptoms appear, and may look at the tiny capillaries at the base of the nails, which are often larger in secondary Raynaud's.

Blood tests described by NHS inform include a full blood count, an antinuclear antibodies (ANA) test, which looks for the overactive immune response common in scleroderma and lupus, and an erythrocyte sedimentation rate. Further testing helps decide whether it is primary or secondary, and secondary Raynaud's may need referral to a specialist.

The NHS and NHS inform give consistent advice. Keep your whole body warm, especially hands and feet, and wear gloves and warm footwear in cold weather. Keep your home warm and avoid sudden changes in temperature. Stopping smoking improves circulation. Regular exercise helps circulation and stress, and breathing exercises or yoga may help you relax.

The NHS says too much caffeine from tea, coffee, cola and chocolate may trigger symptoms. NHS inform adds that if stress is hard to control you may benefit from counselling. If vibrating tools are the cause, NHS inform advises asking for low-vibration tools, taking breaks, keeping warm and telling your employer early, as stopping at an early stage may allow full recovery.

If self-help is not enough, a GP may prescribe nifedipine, a calcium channel blocker that widens blood vessels. NHS inform says it is the only medicine licensed for Raynaud's in the UK, may be taken daily or only in cold spells, and has common side effects including swelling of the hands and feet, headaches, palpitations, dizziness and constipation. Do not drink grapefruit juice with it.

NHS inform notes that other medicines such as fluoxetine and sildenafil have been used but with limited evidence, and are unlicensed for Raynaud's. Surgery, such as sympathectomy, is rare and reserved for severe cases where a finger may lose its blood supply. If a medicine seems to be the cause, your doctor may ask you to stop it to see whether symptoms improve.