Raynaud's phenomenon: fingers that turn white in the cold

What it is, in plain words

In Raynaud's phenomenon, the small arteries in the fingers and toes over-react to cold or stress and clamp shut. Blood flow stops, then returns. This produces the classic sequence of colours: white as flow stops, blue as the remaining blood loses oxygen, then red and painful as flow rushes back.

Signs to look out for

• Fingers turning sharply white with a clear border, then blue, then red
• Numbness, then throbbing and tingling on rewarming
• Attacks lasting minutes to under an hour, triggered by cold air, cold water, freezer aisles or emotion
• Toes, ears, nose and nipples can also be affected
• Ulcers or sores at the fingertips in secondary forms

Why it happens

Primary Raynaud's usually begins before age 30, affects both hands symmetrically and is harmless. Secondary Raynaud's starts later and points to an underlying disease such as scleroderma, lupus or Sjogren syndrome, or to vibrating tool use, certain medicines including beta-blockers, or smoking.

How doctors confirm it

Nailfold capillaroscopy examines the tiny vessels at the nail base, and antibody blood tests screen for connective tissue disease. Abnormal results move the diagnosis towards a secondary cause needing follow-up.

Treatments and solutions

• Keeping the whole body warm, not just the hands: hats, layers, thermal gloves, hand warmers, gloves for the freezer aisle
• Stopping smoking, which constricts vessels, and reviewing medicines that trigger attacks
• Rewarming gently in lukewarm water and swinging the arms, avoiding direct heat on numb skin
• Calcium channel blockers such as nifedipine for frequent or severe attacks
• Specialist treatments including sildenafil, prostacyclin infusions or botulinum injections for ulcers in secondary disease

Living with it day to day

Manage stress, since emotion alone can trigger attacks, and protect the skin: even small fingertip wounds heal slowly when circulation is impaired.

When to seek medical help

See a doctor if attacks start after 30, affect only one hand, cause fingertip ulcers, or come with joint pain, rash, dry eyes, reflux or tight skin.

This article explains general health information in simple language. It does not replace advice from your own doctor.