Raynaud Phenomenon: Why Fingers and Toes Turn White or Blue in the Cold, and What Helps

Raynaud phenomenon — also called Raynaud disease or Raynaud syndrome — affects the blood vessels. In an attack (or episode), vessels narrow and blood flow drops, usually in the fingers and toes, which turn cold and numb and may change color, usually to white or blue. Attacks are set off by cold or stress.

Two types

How attacks happen

Researchers don't know exactly why some people get Raynaud phenomenon, but they understand how an attack works. In the cold, the body saves heat by narrowing the blood vessels in the top layer of the skin, moving blood deeper. In Raynaud phenomenon, the vessels in the hands and feet narrow quickly in response to cold or stress — and stay narrowed a long time.

Who is more likely to get it

Primary:

• women more than men;
• people under 30 — it often starts in the teenage years;
• people with a family member who has it.

Secondary:

• certain diseases — lupus, scleroderma, rheumatoid arthritis (RA), carpal tunnel syndrome and connective tissue disorders;
• certain medicines — for high blood pressure, migraines and attention deficit hyperactivity disorder (ADHD) — can cause similar symptoms or make them worse;
• work exposures: repeated use of vibrating tools such as a jackhammer, or cold or certain chemicals.

Symptoms

Attacks usually come with cold — grabbing something from the freezer, or walking into an air-conditioned building on a warm day. They mostly affect fingers and toes, but sometimes the ears, nose, lips or nipples.

• The skin turns cold and numb, and may go white or blue for lack of oxygen — harder to see on darker skin.
• As blood returns, the skin may tingle, throb or turn red.
• An attack lasts minutes to hours.

For many people, especially with the primary type, symptoms are mild. The secondary type is often more severe, sometimes causing skin ulcers (open sores from poor blood flow) or infections.

Diagnosis

There's no specific test. Your provider will take your medical history, ask about symptoms, do a physical exam, and may order blood and other lab tests to look for conditions that could be causing it and to tell which type you have.

Treatment and prevention

Most people control symptoms by not getting cold. If that isn't enough, medicines and sometimes surgery can help. The secondary type is more likely to need treatment — including treating the underlying condition, perhaps with a rheumatologist (a doctor for joints, muscles and bones).

You can't prevent Raynaud phenomenon, but you can prevent attacks:

• during an attack, put your hands or feet somewhere warm — under warm (not hot) water or a heating pad;
• keep your body, especially hands and feet, warm in cold weather;
• avoid triggers, such as certain medicines and stress;
• quit smoking, or don't start;
• manage stress.

Sources

Based on "Raynaud Phenomenon," MedlinePlus, U.S. National Library of Medicine, with information from NIH's National Institute of Arthritis and Musculoskeletal and Skin Diseases; a work of the United States government in the public domain.