What is Raynaud’s phenomenon?

Raynaud’s phenomenon is an exaggerated response of the blood vessels in your fingers and toes to cold or stress. When triggered, the small arteries that supply blood to your skin narrow dramatically — far more than they should — temporarily limiting blood flow.

The classic pattern is a color sequence: fingers turn white (blood flow stops), then blue (oxygen runs out), then red (blood flow returns, often with throbbing or tingling). Not everyone gets all three colors, and the pattern can vary between episodes. Toes, ears, and the tip of the nose can also be affected.

Raynaud’s is common — it affects roughly 3–5% of the general population. For many people it’s a nuisance that’s managed entirely with behavioral strategies. For others — especially those with an underlying autoimmune condition — it requires closer monitoring and sometimes medication.

Primary vs. secondary Raynaud’s

Primary Raynaud’s occurs on its own, without an underlying disease. It’s the most common form, usually appears in young women, and is generally mild
Secondary Raynaud’s occurs alongside another condition — most often scleroderma, lupus, mixed connective tissue disease, or inflammatory myositis

Secondary Raynaud’s tends to be more severe and carries a higher risk of complications like digital ulcers — small, painful sores on the fingertips caused by prolonged lack of blood flow. When we diagnose Raynaud’s, we routinely check bloodwork and examine your nail fold capillaries under magnification to determine whether an underlying condition is driving it.

Avoiding triggers

The most effective treatment for Raynaud’s is preventing episodes in the first place:

Cold exposure is the biggest trigger — not just cold weather, but reaching into the freezer, holding cold drinks, or air-conditioned rooms
Stress and emotional upset can trigger episodes even in warm environments
Vibrating tools — power tools, lawn equipment — can provoke vasospasm
Smoking and nicotine constrict blood vessels and make Raynaud’s significantly worse
Certain medications can worsen symptoms — pseudoephedrine (Sudafed), some beta-blockers, ergotamine-based migraine medications, and stimulant ADHD medications are common culprits; talk to us before stopping any prescribed medication, but let us know what you’re taking

Practical warming strategies

When it comes to staying warm with Raynaud’s, strategy matters more than just adding layers:

Warm your core, not just your hands — your body shunts blood away from extremities when your core temperature drops, so a warm torso means warmer fingers
Mittens are better than gloves — fingers kept together share heat; lined mittens or ski mittens work well
Chemical hand warmers (HotHands or similar) are inexpensive and effective — keep them in coat pockets, in the car, and at your desk; the reusable gel warmers work too
Layer effectively: a base layer, insulating layer, and windproof outer layer make a bigger difference than one heavy coat
Pre-warm your car before getting in during cold weather
Wear socks to bed if your toes are affected
Run warm water over your hands at the first sign of an episode — this is the fastest way to abort an attack
Use insulated cups for cold drinks, and wear light gloves when handling frozen food

When Raynaud’s is just a nuisance vs. when to escalate

Most people with Raynaud’s manage fine with trigger avoidance and warming strategies. Contact us if you notice:

Digital ulcers — open sores on your fingertips or toes that aren’t healing
Severe, prolonged color changes — an episode lasting more than 20–30 minutes despite rewarming
Asymmetric attacks — one hand affected much more than the other, or involvement of a single finger
Pain that persists after the color returns to normal
New onset of Raynaud’s after age 35–40 — this warrants investigation for underlying causes

If you develop a digital ulcer — a painful open sore on a fingertip or toe — call us promptly. Digital ulcers can become infected and may need specialized wound care. Do not wait for a routine appointment.

Medications for Raynaud’s

When behavioral strategies aren’t enough — especially if episodes are frequent, prolonged, or you’re developing tissue damage — medications can help:

Calcium channel blockers are the first-line treatment. Nifedipine (extended-release) and amlodipine are the most commonly used. They relax and open the small blood vessels, making episodes less frequent and less severe
Common side effects include headache, ankle swelling, flushing, and lightheadedness — these often improve after the first week or two
We usually start at a low dose and increase as needed
Some patients only need medication during cold months and can taper off in warmer seasons
Other medications exist for severe or refractory cases — including topical nitroglycerin paste applied to affected fingers, sildenafil (Viagra, used off-label for its blood vessel effects), and in rare cases, IV prostacyclins — but these are reserved for situations where first-line options aren’t sufficient

What you can do right now

The single most impactful thing you can do is prepare before you’re cold. Once an episode starts, rewarming takes time and can be painful. Prevention is faster and more comfortable than treatment:

Stock up on hand warmers — keep them everywhere
Invest in good mittens and a warm core layer
Identify which situations trigger your episodes and plan around them
If you smoke, quitting will make a measurable difference

Raynaud’s is manageable for the vast majority of patients. If conservative measures aren’t keeping you comfortable, medication can help — and we’d rather start it proactively than wait for complications.

This handout is provided for educational purposes and does not replace individualized medical advice. Always follow the specific instructions given by your rheumatologist.

Managing Raynaud's Phenomenon