Raynaud’s Phenomenon – A Guide to Cold-Induced Colour Changes and Vascular Spasms
What Is Raynaud’s Phenomenon?
Raynaud’s phenomenon (RP) is a condition in which small blood vessels temporarily spasm in response to cold or stress, reducing blood flow to the extremities. It most commonly affects the fingers and toes, but can also involve the ears, nose, lips, or nipples.
During an episode, affected skin often changes colour in three phases:
- White (Ischaemia):Lack of blood flow causes pallor and numbness.
- Blue (Cyanosis):Oxygen-deprived blood pools, turning the area blue.
- Red (Reperfusion):Blood returns rapidly, causing redness, tingling, and pain.
Episodes may last minutes to hours and vary in frequency. Triggers include cold weather, emotional stress, and certain medications.
Types of Raynaud’s Phenomenon
There are two main types:
- Primary Raynaud’s (PRP)
- Most common and typically starts between ages 15–30.
- Not linked to another medical condition.
- Generally mild, with no long-term tissue damage.
- More common in women and may resolve over time.
- Secondary Raynaud’s (SRP)
- Associated with underlying health conditions, especially autoimmune diseases (e.g., scleroderma, lupus).
- Often more severe and may lead to skin ulcers or tissue death.
- Usually begins after age 40 and may involve one side of the body more than the other.
- Requires close medical supervision, often with specialist input.
Common Triggers and How to Avoid Them
Triggers:
- Cold exposure (even mild)
- Emotional stress
- Smoking and nicotine use
- Caffeine
- Certain medicines (e.g., beta-blockers, decongestants, migraine drugs)
- Vibrating tools (e.g., jackhammers)
Prevention Tips:
- Dress warmly, especially hands, feet, and head.
- Use gloves when handling cold objects.
- Gradually transition between warm and cold environments.
- Practise stress-reducing techniques (e.g., breathing exercises, yoga).
- Avoid smoking and limit caffeine.
- Review medications with your GP.
Diagnosing Raynaud’s Phenomenon
Diagnosis starts with a detailed history and physical examination. Key points include:
- Symptom pattern (colour changes, triggers, symmetry)
- Age at onset
- Family history
- Examination of hands, nails, and pulses
Investigations may include:
- Blood tests:ANA, ESR, ENA panel, thyroid function
- Nailfold capillaroscopy:Looks at blood vessels near fingernails for signs of damage
- Specialist referral:Usually to a rheumatologist if secondary Raynaud’s is suspected
Treatment Options
- Lifestyle and Self-Care (First-line for all types):
- Keep warm (layers, gloves, socks)
- Manage stress
- Quit smoking
- Stay active and hydrated
- Avoid known triggers
- Medications (for moderate to severe or secondary cases):
- Calcium channel blockers(e.g., nifedipine, amlodipine) – first choice for reducing frequency and severity
- PDE5 inhibitors(e.g., sildenafil) – improve blood flow
- Losartan or fluoxetine– for those who can’t tolerate other drugs
- Iloprost (IV)– used in severe cases with digital ulcers
- Topical nitrates– for local relief
- Low-dose aspirin– for those at risk of blood clots
- Procedures (for advanced or non-responsive cases):
- Digital sympathectomy:A surgical option in severe cases with ulcers or tissue death
- Botox injections:May help relieve pain and improve circulation (experimental)
- Amputation or debridement:Only if tissue has died or severe infection is present
Complications of Secondary Raynaud’s
- Painfuldigital ulcers
- Infectionsfrom open sores
- Pitting scarsor fingertip deformities
- Gangreneand potential need for amputation
- Significantloss of hand function and reduced quality of life
When to See a Doctor
Consult a GP or rheumatologist if:
- Attacks are severe, frequent, or worsening
- Symptoms start after age 40
- One hand is affected more than the other
- You have skin ulcers, dark patches, or changes in skin texture
- You have symptoms of an autoimmune disease (e.g., joint pain, rashes)
Seek urgent care if:
- Fingers turn black or severely painful
- You develop a sudden high fever with hand ulcers
- There are signs of serious infection or tissue death
Living with Raynaud’s: Day-to-Day Impact
- Simple tasks (buttoning shirts, holding cold items) may be difficult
- RP can affect work, hobbies, and social life
- Pain, stress, and unpredictability can lead to emotional strain
- Regular hand exercises and protective measures help preserve function
Call-to-Action
If you experience colour changes in your fingers or toes when cold or stressed, speak to your GP. Early diagnosis helps prevent complications, especially in secondary Raynaud’s.
For more support, visit www.TheArmDoc.co.uk or phone 020 3384 5588 to book an appointment. You can also email Info@TheArmDoc.co.uk for advice.
Disclaimer
This leaflet is for general information only and does not replace medical advice. Always consult a healthcare professional if you have symptoms or concerns.