Raynaud’s Phenomenon

Raynaud's phenomenon is an exaggerated narrowing of the small arteries in the fingers and toes in response to cold or emotional stress. The digits turn white, then blue, and then red and tingling as the blood returns.

In most people it is primary Raynaud's: a harmless if uncomfortable tendency that starts in the teens or twenties and is not linked to any disease. In a minority it is secondary to another condition, most importantly scleroderma and other connective tissue diseases, and it can then be severe enough to cause finger ulcers.

Symptoms

• Fingers or toes turning white and then blue in the cold
• Numbness and a dead feeling during attacks
• Redness, throbbing and tingling on rewarming
• Attacks triggered by cold water, air conditioning, a freezer or stress
• The nose, ears, lips or nipples are sometimes affected
• Painful sores or pitted scars on the fingertips in secondary Raynaud's

Causes and risk factors

Primary Raynaud's has no known cause. It is more common in women, in cold climates and in families. Secondary Raynaud's arises from underlying conditions that damage the blood vessel lining or thicken the blood: scleroderma, lupus, mixed connective tissue disease, Sjogren's syndrome, vibrating tools, some medicines including beta blockers, migraine drugs, ADHD stimulants and certain chemotherapy agents, smoking, an underactive thyroid and, rarely, blood disorders. Onset after the age of 30 to 40, attacks on one side only, severe pain or ulcers point towards a secondary cause.

How it is diagnosed

• History and examination: A typical description, or phone photographs of an attack, usually establish the diagnosis.
• Nailfold capillaroscopy: Magnified inspection of the tiny vessels at the base of the nail. Abnormal loops strongly suggest scleroderma-spectrum disease.
• Autoantibody blood tests: ANA, with anticentromere and anti-Scl-70 antibodies if the ANA is positive. Blood count, inflammatory markers and thyroid function are added.
• Vascular studies: Doppler or arterial imaging if one hand alone is affected or the pulses are reduced.

Treatment options

• Keeping warm: Keep the whole body warm, not only the hands. Layers, gloves, hand warmers and avoiding sudden changes in temperature are the most effective measures.
• Stopping smoking and reviewing medicines: Nicotine and several common drugs narrow the small vessels.
• Calcium channel blockers: Nifedipine or amlodipine reduce the number and severity of attacks. They are often taken only in winter.
• Other vasodilators: Sildenafil or tadalafil, losartan, fluoxetine or topical nitrate for troublesome cases.
• Intravenous iloprost: Hospital infusions over several days for severe attacks or finger ulcers.
• Bosentan, botulinum toxin and sympathectomy: Reserved for recurrent ulcers in scleroderma or threatened tissue.

When it is urgent

A finger or toe that stays white or blue and painful and does not recover with warming, a new black area, or a fingertip ulcer with spreading redness, pus or fever needs urgent hospital assessment near you in order to save tissue.

Travelling to Türkiye for treatment

Primary Raynaud's does not justify travel. A visit can be helpful if attacks began in adult life or are severe and you want a rheumatology assessment with capillaroscopy and a full antibody panel within a few days, to find out whether a connective tissue disease lies behind it. Ongoing prescriptions and winter-time adjustments are best handled by your own doctor. Iloprost infusions take about 5 days as a day patient and may need repeating.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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