Overview of Raynaud’s Phenomenon
Raynaud’s phenomenon is a condition that causes the blood vessels in the extremities to narrow, restricting blood flow. The episodes or “attacks” usually affect the fingers and toes. In rare cases, attacks occur in other areas such as the ears or nose. An attack usually happens from exposure to cold or emotional stress.
There are two types of Raynaud’s phenomenon—primary and secondary. The primary form has no known cause, but the secondary form is related to another health issue, especially autoimmune diseases like lupus or scleroderma. The secondary form tends to be more serious and to need more aggressive treatment.
In most people, lifestyle changes such as staying warm keep symptoms under control, but in severe cases, repeated attacks lead to skin sores or gangrene (death and decay of tissue). The treatment depends on how serious the condition is and whether it is the primary or secondary form.
Who Gets Raynaud’s Phenomenon?
Anyone can get Raynaud’s phenomenon, but some people are more likely to have it than others. There are two types and the risk factors for each are different.
The primary form of Raynaud’s phenomenon, which is of unknown cause, has been linked to:
- Sex. Women get it more often than men.
- Age. It usually occurs in people younger than age 30 and often starts in the teenage years.
- Family history of Raynaud’s phenomenon. People with a family member who has Raynaud’s phenomenon have a higher risk of getting it themselves, suggesting a genetic link.
The secondary form of Raynaud’s phenomenon occurs in combination with another disease or an environmental exposure. Factors that have been linked to secondary Raynaud’s phenomenon include:
- Diseases. Among the most common ones are lupus, scleroderma, inflammatory myositis, rheumatoid arthritis, and Sjögren’s syndrome. Conditions such as certain thyroid disorders, clotting disorders, and carpal tunnel syndrome have also been linked to the secondary form.
- Medications. Medications used to treat high blood pressure, migraines, or attention-deficit/hyperactivity disorder may cause symptoms similar to Raynaud’s phenomenon or make underlying Raynaud’s phenomenon worse.
- Work-related exposures. Repeated use of vibrating machinery (such as a jackhammer), or exposure to cold or certain chemicals.
Types of Raynaud’s Phenomenon
There are two types of Raynaud’s phenomenon.
- Primary Raynaud's phenomenon has no known cause. It is the more common form of the condition.
- Secondary Raynaud's phenomenon is associated with another problem, such as a rheumatic disease like lupus or scleroderma. Factors such as exposure to cold or certain chemicals may also underlie this form. The secondary form is less common but typically more serious than the primary form due to damage that occurs to the blood vessels.
Symptoms of Raynaud’s Phenomenon
Raynaud’s phenomenon happens when episodes or “attacks” affect certain parts of the body, especially the fingers and toes, causing them to become cold and numb, and change colors. Exposure to cold is the most common trigger, such as grabbing hold of a glass of ice water or taking something out of the freezer. Sudden changes in ambient temperature, such as when entering an air-conditioned supermarket on a warm day, can lead to an attack.
Emotional stress, cigarette smoking, and vaping can also trigger symptoms. Parts of the body besides the fingers and toes, such as the ears or nose may be affected as well.
Raynaud’s attacks. A typical attack progresses as follows:
- The skin of the affected part of the body turns pale or white due to lack of blood flow.
- The area then turns blue and feels cold and numb, as the blood that is left in the tissue loses its oxygen.
- Finally, as you warm up and circulation returns, the area turns red and may swell, tingle, burn, or throb.
Only one finger or toe may be affected at first; then, it may move to other fingers and toes. The thumbs are less likely to be affected than the other fingers. An attack may last a few minutes or a few hours, and the pain associated with each episode can vary.
Skin ulcers and gangrene. People with severe Raynaud’s phenomenon can develop small, painful sores, especially at the tips of the fingers or toes. In rare cases, an extended episode (days) of a lack of oxygen to tissues can lead to gangrene (cellular death and decay of body tissues).
For many people, especially those with the primary form of Raynaud’s phenomenon, the symptoms are mild and not highly troublesome. People with the secondary form tend to have more severe symptoms.
Causes of Raynaud’s Phenomenon
Scientists do not know exactly why Raynaud’s phenomenon develops in some people, but they do understand how attacks happen. When a person is exposed to cold, the body tries to slow the loss of heat and maintain its temperature. To do so, blood vessels in the surface layer of the skin constrict (narrow), moving blood from vessels near the surface to those deeper in the body.
In people with Raynaud’s phenomenon, blood vessels in the hands and feet react to cold or stress, narrowing quickly and staying constricted for a long period. This causes the skin to turn pale or white, then bluish as the blood left in the vessels becomes depleted of oxygen. Eventually, when you warm up and the vessels expand again, the skin flushes and may tingle or burn.
Many factors, including nerve and hormonal signals, control blood flow in skin, and Raynaud’s phenomenon happens when this complex system gets disrupted. Emotional stress releases signaling molecules that cause blood vessels to narrow, which is why anxiety can trigger an attack.
More women than men are affected by primary Raynaud’s phenomenon, suggesting that estrogen may play a role in this form. Genes may also be involved: The risk of the condition is higher in people with a relative who has it, but the specific genetic factors have not yet been definitively identified.