Skip to main content

Saturn Medic

Raynaud’s Phenomenon

Clinical Subject Page

Raynaud's Phenomenon

Also called

Raynaud's Disease

ICD-10

I73.00

Specialty

Cardiology

Onset

Chrnoic

Reviewed

July 2026

On This Page

Overview

Raynaud’s Phenomenon is a condition in which small blood vessels in the fingers or toes suddenly narrow, usually because of cold exposure or emotional stress.

This narrowing is called a vasospastic attack. It reduces blood flow temporarily.

Etiology & Risk Factors

-Main cause of Raynaud’s Phenomenon

  • Spasm of small blood vessels in fingers or toes

Triggers

  • Cold
  • Emotional stress

Primary Raynaud

  • No clear cause
  • Often starts before age 30
  • More common in female individuals

Secondary Raynaud

Linked to:

  • Smoking
  • Certain drugs: beta blockers, ergotamine, bleomycin
  • Vibrating tools or repeated hand trauma
  • Connective tissue disease, especially scleroderma
  • Vascular disease
  • Neurologic problems, such as carpal tunnel syndrome

Pathophysiology

Cold or emotional stress → Exaggerated vasoconstriction → Digital arteries/arterioles narrow → Reduced blood flow to fingers/toes → Ischemia: white → Hypoxia: blue/purple → Blood flow returns → Reactive hyperemia: red

Clinical Presentation

      • sually affects the fingers and sometimes the toes
      • Often occurs bilaterally
      • Triggered by cold or emotional stress
      • Thumb is usually spared in primary Raynaud
      • May cause numbness, pain, or tingling, especially during rewarming

      Classic color change

      Cold/stress trigger → White → Blue/purple → Red

      • White = ischemia from reduced blood flow
      • Blue/purple = low oxygen
      • Red = blood flow returns

History Taking

  • What triggers it: cold or emotional stress?
  • Which areas are affected: fingers, toes, ears, nose, tongue?
  • Is it on both sides?
  • Does the thumb stay normal?
  • What color changes occur: white → blue/purple → red?
  • Do you feel numbness, pain, or tingling?
  • How long does an episode last?
  • Does it improve after warming?
  • Any severe pain, ulcers, or tissue damage?
  • Any signs of systemic disease: skin thickening, telangiectasias, photosensitivity, patchy alopecia?
  • Any history of migraine or irritable bowel syndrome?
  •  

Physical Examination

    • Fingers or toes may turn white, blue/purple, then red
    • Usually affects both sides
    • Thumb is often spared in primary Raynaud
    • May have numbness, pain, or tingling
    • Look for ulcers, pitting, or tissue damage
    • Check for signs of connective tissue disease:
      • Skin thickening
      • Sclerodactyly
      • Telangiectasias
      • Calcinosis

    Usually normal

    • Pulses
    • Allen test
    • Blood pressure in both arms

Investigations

      • Usually a clinical diagnosis based on history, photos, or observed color change.

      Basic investigations

      • CBC
      • ANA
        • If positive → ENA panel
      • ESR or CRP

      Special test

      • Nailfold capillary microscopy
        • Helps detect early connective tissue disease

      Consider imaging

      • Cervical spine / upper thoracic imaging
        • If concern for thoracic outlet syndrome or cervical rib

Diagnosis

    • Raynaud’s Phenomenon is a clinical diagnosis
    • Diagnose by history or photo/direct observation of attack
    • Trigger: cold or emotional stress
    • Color change: white → blue/purple → red
    • At least white + blue/purple supports diagnosis

    Important Dx step

    Decide if it is:

    • Primary: young onset, reversible, no tissue damage
    • Secondary: late onset, severe attacks, ulcers/pitting/gangrene, signs of connective tissue disease
Home / Home / Clinical Cases / Cardiovascular System Clinical Cases / Raynaud’s Phenomenon
Related Topics

Management

    • Avoid cold
    • Wear warm gloves/layers
    • Manage stress
    • Stop smoking
    • Avoid vibration exposure
    • Stop trigger drugs if possible, e.g. beta blockers, ergotamine

    If symptoms persist

    • Use calcium channel blocker
      • Preferred: nifedipine
      • Alternatives: amlodipine or felodipine

    Secondary Raynaud

    • Find and treat the underlying cause
    • Consider rheumatology/immunology referral

    Severe disease

    • Specialist management
    • Options include IV prostanoids, PDE-5 inhibitors, or procedures for severe ischemia

Complications

  • Severe pain
  • Digital ischemia
  • Finger/toe ulcers
  • Pitting or tissue injury
  • Tissue loss
  • Gangrene — rare

Prognosis

  • usually good prognosis
  • Attacks are usually reversible
  • Symptoms often improve with trigger avoidance
  • Episodes usually last 15–20 minutes after removing the trigger
  • Secondary Raynaud: prognosis depends on the underlying cause
  • Secondary Raynaud can be more severe and may lead to:
    • Digital ulcers
    • Tissue loss
    • Rarely, gangrene

Key Points / Clinical Pearls

  • in Raynaud’s Phenomenon, Blood vessel spasm in fingers or toes
  • Triggered by cold or stress
  • Color change: white → blue → red
  • Primary Raynaud: no clear cause, usually mild
  • Secondary Raynaud: due to disease, drugs, smoking, or vibration
  • Diagnosis is mainly by history or photos
  • Tests check for secondary causes: CBC, ANA, ESR/CRP
  • Main treatment: keep warm and avoid triggers
  • Medication if needed: nifedipine
  • Tissue damage, ulcers, or gangrene suggest secondary Raynaud