Health condition · Clinically reviewed
Raynaud’s phenomenon, cold, colour-changing fingers — primary or secondary.
Vasospasm of small arteries triggered by cold or stress. Primary Raynaud’s is benign; secondary Raynaud’s (connective tissue disease) needs proper work-up.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
- 02
Sourced, not summarised
Every claim is checked against NICE, specialist society guidance or a peer-reviewed source you can see at the end.
- 03
Updated for 2026
Reflects current UK guidance on Raynaud’s work-up, medication and when to escalate.
Key facts
Raynaud’s at a glance.
The essentials, in plain English — what it is, the classic sign, primary vs secondary, and how it is treated in the UK today.
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What it is
Episodic vasospasm of the small arteries in the fingers and toes, triggered by cold or stress.
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The classic sign
A triphasic colour change: white (pallor) → blue (cyanosis) → red (reperfusion).
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Primary Raynaud’s
Usually benign — younger onset, symmetric, no underlying disease, normal autoantibodies and capillaroscopy.
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Secondary Raynaud’s
Associated with systemic sclerosis, SLE, rheumatoid arthritis and other connective tissue diseases.
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Key differentiating test
Nailfold capillaroscopy distinguishes primary from secondary Raynaud’s.
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First-line medication
Nifedipine (a calcium-channel blocker) is first-line when lifestyle measures are not enough.
Why this guide matters
The two Raynaud’s, and why the difference matters.
Most people with cold, colour-changing fingers have benign primary Raynaud’s. A minority have secondary Raynaud’s — the earliest sign of a connective tissue disease. Telling them apart changes everything.
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Primary is usually harmless
Younger onset, symmetric, normal autoantibodies and capillaroscopy — reassure and self-manage.
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Secondary needs work-up
Positive autoantibodies or abnormal capillaroscopy warrant rheumatology involvement.
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Digital ulcers are a red flag
Open sores on fingertips or gangrene mean same-day escalation, not next week.
How the diagnosis is made
From history and colour change to a clear plan.
The steps a UK GP or rheumatologist will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
History, autoantibodies and capillaroscopy
Phase 2 · Confirming
Baseline checks and skin/ulcer screen
Phase 3 · Managing
Referral and trigger-avoidance plan
- 01
Recognising
History and colour-change pattern
Triggers, duration, symmetry and the classic white → blue → red sequence are the starting point.
- 02
Recognising
Autoimmune screen
ANA, ENA, RF and anti-CCP to look for an underlying connective tissue disease.
- 03
Recognising
Nailfold capillaroscopy
A magnified look at the capillaries at the nail base — the key test to separate primary from secondary Raynaud’s.
- 04
Confirming
Baseline BP and ECG
A cardiovascular baseline before starting vasodilator medication.
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Confirming
Screen for ulcers or digital pits
Small pitted scars at the fingertips are a red flag for scleroderma-spectrum disease.
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Managing
Rheumatology referral if secondary suspected
Abnormal capillaroscopy, positive autoantibodies or systemic features prompt onward referral.
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Managing
Trigger avoidance advice
Cold, stress and nicotine are the three most modifiable triggers — with a written plan for winter.
Typical timeline: 2-8 weeks from first assessment to a settled plan.
Symptoms
What a Raynaud’s attack actually looks like.
The classic triphasic colour change and the sites most commonly affected — with the red flag that changes the plan.
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White phase
Fingers turn sharply white as the small arteries spasm and blood flow drops.
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Blue phase
Skin turns dusky blue (cyanosis) as oxygen is used up in the tissues.
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Red phase
Fingers flush red and can throb or tingle as blood flow returns.
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Fingers most commonly
Most attacks affect the fingers, often symmetrically and starting at the tips.
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Toes
Toes are the second most common site — noticed in cold weather or after cold-water exposure.
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Nose
The tip of the nose can pale and go numb in the cold.
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Ears
Earlobes can turn white then dusky, particularly in windy, cold weather.
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Red flag
Digital ulcers or gangrene — urgent rheumatology or vascular assessment on the same day.
Treatment
How Raynaud’s is treated in the UK.
Warmth and trigger avoidance first, then a stepwise ladder of medications reserved for severe or secondary disease.
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Warm gloves and heated pads
Layered gloves, heated inserts and hand warmers are the mainstay of prevention through winter.
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Trigger avoidance
Cold, stress and nicotine are the three modifiable triggers — smoking cessation is particularly important.
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Nifedipine or amlodipine
Calcium-channel blockers are first-line drug treatment — started low and titrated to effect.
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Sildenafil
A phosphodiesterase-5 inhibitor used in severe secondary Raynaud’s under specialist care.
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Iloprost infusion
A prostacyclin analogue given by IV infusion for critical digital ischaemia or ulcers.
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Bosentan
An endothelin-receptor antagonist used to prevent new digital ulcers in scleroderma.
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Botulinum toxin
Local injections around the digital arteries — a specialist option for resistant disease.
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Sympathectomy
Surgical division of sympathetic fibres — a last-resort option for severe, drug-resistant cases.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP or rheumatologist knows your history and can tell you which parts apply to you. If in doubt, get assessed.
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National Institute for Health and Care Excellence (NICE). Clinical Knowledge Summary: Raynaud’s phenomenon.
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Scleroderma & Raynaud’s UK (SRUK). Patient information and clinical resources.
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British Society for Rheumatology. Guideline on the treatment of systemic sclerosis.
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EULAR recommendations for the treatment of systemic sclerosis.
Red flags
When Raynaud’s becomes an emergency.
Most Raynaud’s is a nuisance, not a threat. These are the situations where the plan must change today.
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Digital ulceration
Open sores on the fingertips need same-day rheumatology or vascular assessment.
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Gangrene
Black, dead tissue on a digit is a vascular emergency — attend the emergency department.
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New connective tissue disease features
Tight, shiny skin, telangiectasia or Raynaud’s starting alongside joint or skin changes — think scleroderma.
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Onset after 40 with systemic features
New Raynaud’s in an older adult, particularly with weight loss or fatigue, needs urgent work-up.
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Asymmetric attacks
One-sided attacks suggest a local vascular problem rather than typical Raynaud’s.
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Pulmonary hypertension features
Breathlessness on exertion in someone with scleroderma spectrum disease — needs echocardiogram.
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Interstitial lung disease features
Dry cough or breathlessness in a Raynaud’s patient with a positive autoimmune screen.
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Scleroderma renal crisis
Sudden severe hypertension and kidney impairment in scleroderma — emergency admission.
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Pregnancy planning
Some Raynaud’s medications are unsafe in pregnancy — plan changes with your specialist.
Living with it
A long-term condition, but a very manageable one.
Four things that make the biggest difference day to day — habits, triggers, medication and reviews.
A quiet reminder
Prevention beats rescue, every time.
Warming up before you go out is far more effective than warming up an attack that has already started.
- 01 Daily habits
Layer up, plan ahead
Gloves before you feel cold, warm the car before you leave, and keep hand warmers to hand in winter.
- 02 Triggers
Cold, stress and nicotine
Stopping smoking is one of the single most effective steps — nicotine constricts small arteries.
- 03 Medication
Nifedipine at the right dose
Start low, titrate up, and take at the same time each day — headache and flushing usually settle within two weeks.
- 04 Reviews
Annual review, sooner if worsening
A yearly review to check attack frequency, medication and any new features suggesting secondary disease.
Frequently asked
Everything we get asked about Raynaud’s.
Quick answers on the two Raynaud’s, tests, medication and when to worry.
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What is Raynaud’s phenomenon?
Episodic vasospasm of the small arteries in the fingers and toes, triggered by cold or stress. Attacks cause a classic triphasic colour change — white, then blue, then red.
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What is the difference between primary and secondary Raynaud’s?
Primary Raynaud’s is a benign, standalone condition. Secondary Raynaud’s is associated with an underlying connective tissue disease such as systemic sclerosis, SLE or rheumatoid arthritis, and can be more severe.
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Which test differentiates the two?
Nailfold capillaroscopy — a magnified look at the capillaries at the base of the nail. Combined with an autoimmune screen, it separates primary from secondary Raynaud’s.
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What is the first-line medication for Raynaud’s?
A calcium-channel blocker — usually nifedipine, or amlodipine as an alternative. Started at a low dose and titrated to effect.
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When are stronger treatments used?
Sildenafil, iloprost infusions or bosentan are reserved for severe secondary Raynaud’s, particularly when digital ulcers develop, and are prescribed under specialist care.
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When should I seek urgent care?
Any open sore on a fingertip, black or dead tissue, or new symptoms suggesting scleroderma should prompt urgent rheumatology or vascular assessment.
Related content
Keep reading.
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Blood tests
The autoimmune screen behind a Raynaud’s work-up.
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Inflammation markers (CRP, ESR)
What raised inflammation numbers mean, and don’t mean.
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Cardiovascular risk assessment
A baseline before starting vasodilator medication.
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