Raynaud's syndrome symptoms: What are the early signs of Raynaud's syndrome?

Overview: What does Raynaud's syndrome feel like?

Raynaud’s syndrome is an exaggerated response to cold temperatures, emotional stress, or windy conditions. During a Raynaud’s attack, blood flow to the fingers or toes stops suddenly in response to cold temperatures or stress, turning the fingers or toes white and cold. Restricted blood flow, called vasoconstriction, is a normal response to cold, but Raynaud’s disease overdoes it. Not only do fingers turn white and cold, they also commonly hurt or tingle, like pins and needles. The fingers may look blue from lack of oxygen, and then red and warm when blood flow returns. Attacks usually last for minutes, but people with severe Raynaud’s may have symptoms lasting hours. In the worst cases, tissues in the fingers or toes die from lack of oxygen. 

Healthcare professionals divide Raynaud’s into two distinct types, primary Raynaud’s and secondary Raynaud’s. Most people have primary Raynaud’s. Attacks begin early in life and aren’t health-threatening. Secondary Raynaud’s is caused by other medical conditions, drugs, or lifestyle and usually begins later in life. It has more serious symptoms, and attacks can severely damage tissues in the fingers and toes. 

What are the early signs of Raynaud's syndrome?

The early signs of Raynaud’s syndrome are episodic attacks triggered by cold or emotional stress. The signs of a Raynaud’s attack are:

• Sudden whitening of the skin of the fingers or toes

• The skin may look blue

• The skin may look red when blood flow returns

• The affected area will feel cold

• Numbness in the affected area

• There may be pain or tingling

Attacks typically last for minutes to hours before blood flow returns to normal. While Raynaud’s attacks usually occur in the fingers or toes, other parts of the body might be affected, such as the nose, the ears, the lips, or the nipples.

Other Raynaud's syndrome symptoms

Raynaud’s syndrome attacks are sudden and characterized by:

• Skin color changes: normal skin color to white to blue to red, but not all people will see all three colors in the course of an attack

• The affected area will feel cold

• Numbness in the affected area

• Pain, tingling, throbbing, or pins and needles feeling in the affected area

• Purple spotting in the affected area may happen during an attack

Primary Raynaud’s syndrome is usually not a serious health problem, though it can be aggravating. However, secondary Raynaud’s can be serious, resulting in tissue damage or, in rare cases, tissue death (gangrene). People with secondary Raynaud’s syndrome may also have other symptoms, such as: 

• Permanent skin discoloration

• Swelling

• Severe pain or numbness in the affected area

• Skin ulcers or blisters

Raynaud's syndrome vs. Raynaud's disease 

For all practical purposes, healthcare professionals use these two names interchangeably. Some healthcare providers may use one term to describe primary Raynaud’s and another to describe secondary Raynaud’s, but there are no rules. The relevant distinction is between primary Raynaud’s and secondary Raynaud’s. They both have the same symptoms, but secondary Raynaud’s is the more severe form of Raynaud’s syndrome.

Types of Raynaud's syndrome: How can I tell which one I have?

Raynaud’s syndrome is divided into two distinct medical conditions: primary Raynaud’s syndrome and secondary Raynaud’s syndrome.

• Primary Raynaud’s is the most common type of Raynaud’s syndrome. About 80% to 90% of people with a Raynaud’s diagnosis have this milder form of the syndrome. Primary Raynaud’s has no known cause and affects women far more than men. The first symptoms typically appear between the ages of 15 and 30. Symptoms are mild and do not cause complications. Over 60% of people with primary Raynaud’s will eventually experience complete remission of symptoms without treatment.

• Secondary Raynaud’s is caused by blood vessel problems, connective tissue disorders, autoimmune disorders, injury, certain types of drugs, or chemical exposure. The first attacks typically occur in people older than the age of 40. Symptoms are often more severe than in primary Raynaud’s, sometimes severe enough to cause gangrene.

The age of onset and severity of symptoms is one way to tell the difference between primary and secondary Raynaud’s. Another way to tell the difference is by cause. Primary Raynaud’s has no cause. However, people with secondary Raynaud’s may have experienced any one of several causes, including: 

• Scleroderma

• Lupus 

• Rheumatoid arthritis

• Sjogren’s syndrome

• Vascular diseases such as atherosclerosis 

• Use of certain drugs such as migraine medications, beta blockers, birth control pills, and over-the-counter decongestants 

• Infections such as parvovirus, hepatitis C, or CMV

• Cold injury like frostbite

• Exposure to certain chemicals

• Chronic use of vibrating tools like jackhammers can cause hand-arm vibration syndrome (HAVS), a type of injury that includes peripheral nerve damage, muscle weakness, secondary Raynaud’s (also called vibration white finger or VWF), and sometimes carpal tunnel syndrome

When to see a doctor for Raynaud's syndrome symptoms

See a doctor if Raynaud’s symptoms are symptomatic. For people with primary Raynaud’s, conservative treatment can help reduce the number of attacks and increase the quality of life. For people with secondary Raynaud’s, treatment can reduce the number and severity of attacks and help prevent serious complications of the disease.

Symptoms such as persistent pain or skin discoloration are signs of tissue death and require emergency treatment.

Healthcare providers diagnose Raynaud’s with a medical history, physical examination, and tests. In a medical history, the clinician will ask about the symptoms, their severity, where they occur, and how often they occur. The clinician will also ask about other symptoms in case there’s an underlying disease. 

A microscopic examination of the skin at the base of the fingernails can help identify secondary Raynaud’s. Called nailfold capillaroscopy, the rheumatologist or dermatologist will examine the nail folds with a stereomicroscope to look for damaged small capillaries. The clinician may also use blood tests such as an antinuclear antibodies (ANA) test or an erythrocyte sedimentation rate (ESR) test to determine an underlying autoimmune cause. 

Complications of Raynaud's syndrome

Primary Raynaud’s is a benign condition that is not associated with complications. Secondary Raynaud’s is more serious and can result in complications such as:

• Tissue death

• Skin ulcers

• Amputation

How to treat Raynaud's syndrome symptoms

Most cases of Raynaud’s are benign and treated with lifestyle changes. However, some people may not benefit from conservative treatment. In those cases, most people will be treated by a rheumatologist, a doctor who specializes in rheumatic arthritis, who will manage the symptoms with prescription medications. If there’s an underlying cause, that will be treated, as well.

Conservative treatments of Raynaud’s include:

• Avoiding exposure to the cold or wind

• Avoiding contact with cold objects

• Keeping the body warm, particularly the hands and feet. Wear gloves and warm socks.

• Managing stress and anxiety

• Avoiding caffeine and other stimulants 

There are no drugs FDA approved to treat Raynaud’s, so healthcare providers turn to drugs that widen blood vessels, including:

• Certain types of high blood pressure (hypertension) drugs called calcium channel blockers

• PDE5 inhibitors such as Viagra (sildenafil) or Cialis (tadalafil)

• Topical nitrates such as nitroglycerin

• Prostaglandin infusions in more severe cases

In severe Raynaud disease that does not respond to treatment, a surgeon may need to cut the nerves that control blood vessel constriction, a procedure called a sympathectomy.

Living with Raynaud's syndrome

No matter what the diagnosis or treatment, people with Raynaud’s can help reduce both the incidence and severity of Raynaud’s attacks by following a few well-established practices:

• Avoid going out in cold weather

• Wear warm clothing when it’s cold outside

• Wear gloves or mittens when it’s cold outside

• Use hand warmers inside gloves or mittens

• Keep indoor temperatures warm—don’t overdo air conditioning on hot days

• Wear warm clothing indoors

• Avoid touching cold objects—take things out of the refrigerator or freezer wearing gloves or a pot holder

• Use insulated glasses for cold drinks

• Manage stress and anxiety

• Avoid stimulants

• Avoid OTC medicines such as decongestants that constrict blood vessels 

• Exercise

• Quit smoking and avoid second-hand smoke

A few tips can help increase blood flow during an attack:

• Act quickly to warm the affected area

• Put the affected area under warm water as soon as possible

• Move your fingers or toes

• Massage the affected area

• Swing the arms around

FAQs about Raynaud's syndrome symptoms

Can Raynaud's turn into lupus?

Secondary Raynaud’s is often associated with lupus, an autoimmune disease that causes inflammation throughout the body. One study found that about half of people with lupus and Raynaud’s are first diagnosed with primary Raynaud’s and then later diagnosed with lupus. However, another study found only a small percentage of people diagnosed with primary Raynaud’s are later diagnosed with lupus.

What foods to avoid if you have Raynaud’s?

Because Raynaud’s can be triggered by anxiety or stress, avoid foods with stimulants such as caffeine. These include coffee, sodas, tea, energy drinks, and chocolate.

Can vitamin D deficiency cause Raynaud's?

Vitamin D does affect blood vessel physiology and has been linked to blood vessel problems such as artery stiffness. However, no study has shown that vitamin D deficiency is associated with Raynaud’s. However, one study showed that people with both Raynaud’s and vitamin D deficiency showed improvement in the frequency and severity of their symptoms after taking vitamin D supplements for 8 weeks. 

What’s next? Additional resources for people with Raynaud's syndrome symptoms

Test and diagnostics

• A review of Raynaud’s disease, Missouri Medicine

• Raynaud’s syndrome, UCSF Department of Surgery

Treatments

• Raynaud disease, StatPearls

• Raynaud’s phenomenon: diagnosis, treatment, and steps to take, NIH National Institute of Arthritis and Musculoskeletal and Skin Diseases

• Raynaud’s syndrome, UCSF Department of Surgery

Scientific studies and clinical trials

• Is there a difference in systemic lupus erythematosus with and without Raynaud’s phenomenon?, Rheumatology International

• Outcomes in primary Raynaud phenomenon: a meta-analysis of the frequency, rates, and predictors of transition to secondary diseases, JAMA

• Raynaud’s phenomenon and vitamin D, Rheumatology International

More information on related health conditions

• Lupus treatments and medications, SingleCare