Raynaud’s Phenomenon
Fingers or toes turn white, then blue, then red when you’re cold or stressed, because small blood vessels clamp down too hard. Usually harmless and manageable with warmth. Sometimes it’s linked with another condition, which is worth checking.
Quick answer: Raynaud’s phenomenon makes fingers or toes turn white, then blue, then red in the cold or with stress, as small blood vessels overreact. About 3 to 5 in 100 people have it. Most cases are ‘primary’ and harmless. Keeping your whole body warm and not smoking help most; nifedipine reduces attacks when needed.
How common. About 3 to 5 in 100 people, more often women. Most (around 8 or 9 in 10) have primary Raynaud’s, which usually starts between the teens and 30s, often runs in families and isn’t linked with any other disease.
Secondary Raynaud’s. Caused by something else: connective tissue diseases such as scleroderma (over 9 in 10 people with scleroderma have Raynaud’s), lupus, rheumatoid arthritis and Sjögren’s; years of using vibrating tools; smoking; and some medicines, including beta-blockers, some migraine medicines and ADHD stimulants. Each year, about 1 to 2 in 100 people with primary Raynaud’s turn out to have a secondary cause.
Symptoms. Fingers or toes go white and numb, then blue, then red, throbbing or tingling as blood returns. Attacks last minutes to a few hours. Ears, nose, lips and nipples can be affected. Not everyone gets all three colours.
Look-alikes. Chilblains (itchy, swollen purple spots after cold), acrocyanosis (constantly blue hands, painless), carpal tunnel syndrome (tingling without colour change), and a blocked artery, which usually affects one hand or foot suddenly.
How it’s diagnosed. From your description; a photo of an attack helps. Your GP will look for clues of a secondary cause and may check blood tests (blood count, inflammation markers and antinuclear antibodies, ANA) and look at the tiny blood vessels at the nail folds with a magnifier.
The Raynaud’s ladder
Warmth and avoiding triggers work for most people. Medicines are for frequent or severe attacks.
- Step 1 · Self-careKeep your whole body warmLayers, a hat, gloves or mittens, warm socks; warm the car first; hand warmers; avoid sudden cold such as freezer aisles.
- Works
- The mainstay. No big trials, but keeping your core warm is what stops vessels clamping
- Cost
- Free to a few dollars
- How long
- Every cold day
- Watch for
- Don’t thaw numb fingers with very hot water; warm them gently.
Gloves alone can’t fix a cold core. Wear the jumper.
- Step 2 · Self-careStop smoking and review triggersSmoking narrows blood vessels. Caffeine and stress can trigger attacks in some people.
- Works
- Stopping smoking improves circulation; strongly recommended
- Cost
- Free; quit aids are PBS-subsidised
- How long
- Ongoing
- Watch for
- Ask your GP to check whether any of your medicines could be adding to it. Don’t stop a prescribed medicine on your own.
Your fingers would like a word about the smoking.
- Step 3 · PrescriptionNifedipine (slow-release)A blood pressure medicine that relaxes small blood vessels. Some take it daily, others only through winter.
- Works
- In a 2017 Cochrane review, calcium channel blockers cut attacks from about 14 to 8 a week (moderate-certainty evidence) and made them slightly less severe
- Cost
- About $15–30 a month; PBS
- How long
- Through cold months or ongoing
- Watch for
- Headache, flushing, dizziness, fast heartbeat and ankle swelling, often easing after a few weeks.
Six fewer white-finger moments a week. Not bad for one tablet.
- Step 4 · SpecialistOther medicines and proceduresFor severe or secondary Raynaud’s: glyceryl trinitrate ointment, sildenafil, infusions such as iloprost for finger ulcers, or botulinum toxin injections.
- Works
- Helpful for some, mostly in secondary Raynaud’s; evidence varies by treatment
- Cost
- Varies; some only through specialists
- How long
- Varies
- Watch for
- Usually managed by a rheumatologist or vascular specialist.
Heavy-duty help for heavy-duty Raynaud’s.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- ‘Circulation’ supplementsProducts sold to boost circulation have no good trial evidence of fewer attacks. Warm clothes do more.
What you can do
- Dress for the cold before you feel it: core warmth first, then hands and feet.
- During an attack, get somewhere warm, swing your arms in circles, or tuck your hands into your armpits.
- Use insulated cups and gloves for cold drinks and the freezer.
- Quit smoking. Our quit smoking guide has options.
- Keep fingertips moisturised and protected from cuts.
- Exercise regularly to improve circulation.
See your GP if
- Symptoms start for the first time after age 30
- Only one side or a single finger is affected
- You also have joint pain, rashes, tight or thickening skin, swallowing trouble, muscle weakness, or dry eyes and mouth
- Attacks are severe, frequent or getting worse
- A child under 12 has symptoms
See a doctor the same day for sores, ulcers or dark or black patches on your fingertips or toes, or a finger that stays white, blue and painful after warming up. Sudden cold, pale, painful hand or foot that doesn’t recover: call 000 (Australia) or your local emergency number.
Outlook. Primary Raynaud’s rarely causes damage and often eases with age. Secondary Raynaud’s needs the underlying condition treated and closer follow-up.
Common questions
What triggers Raynaud’s?
Cold, especially sudden changes like air conditioning or a freezer aisle, and emotional stress. Smoking, caffeine, vibrating tools and some medicines can make it worse.
Is Raynaud’s serious?
Primary Raynaud’s, the common kind, is usually harmless. Secondary Raynaud’s can be a sign of conditions like scleroderma or lupus, and severe attacks can cause sores. New symptoms after 30 or with other symptoms need a check.
Is Raynaud’s an autoimmune disease?
Primary Raynaud’s isn’t. Secondary Raynaud’s is often linked with autoimmune conditions such as scleroderma, lupus and Sjögren’s, which is why your GP may check blood tests.
What’s the fastest way to stop a Raynaud’s attack?
Get somewhere warm, then warm your hands gently: armpits, warm (not hot) water, or swinging your arms in big circles to push blood to the fingers.
What medicine is used for Raynaud’s?
Nifedipine, a calcium channel blocker, is the usual first choice. In a Cochrane review it cut attacks from about 14 to 8 a week. Some people take it only in the colder months.
Can Raynaud’s go away?
Primary Raynaud’s often improves with age and with good warmth habits. Secondary Raynaud’s depends on the condition behind it.
Evidence and more information
- Rirash et al, Cochrane 2017: Calcium channel blockers for primary and secondary Raynaud’s phenomenon
- Am Fam Physician 2014: Raynaud phenomenon
- NHS: Raynaud’s
- NICE CKS: Raynaud’s phenomenon
maladywise.com/raynauds/