Raynaud Phenomenon: Why Fingers and Toes Turn White or Blue in the Cold

What it involves

MedlinePlus describes Raynaud phenomenon as a condition in which cold temperatures or strong emotions cause blood vessel spasms that block blood flow to the affected areas and cause discoloration. When it occurs alone, it is called Raynaud disease.

Who this is for

• Patients whose fingers or toes turn white, then blue, then red after cold or stress
• Patients with painful, tingling fingertips or sores that heal slowly
• Patients with arthritis or an autoimmune condition who notice cold, color-changing hands
• Patients who smoke or use vibrating tools and see their fingers change color

What to expect

• Questions about what triggers the color change, how long it lasts and which fingers or toes are affected
• An exam of the hands and feet and a look at your medicines and other conditions
• Blood work looking for related arthritic or autoimmune conditions, since the practice lists blood work among its services
• A plan that covers warming strategies and a referral if a related condition is found

What an attack looks like

According to MedlinePlus, exposure to cold or strong emotion brings on the changes. The affected areas first turn white, then blue, and when blood flow returns they become red before returning to their usual color. Fingers are most commonly involved, but toes, ears, lips or the nose can change color too. An attack can last from minutes to hours. Many people with the primary form feel little pain, while those with the secondary form are more likely to feel pain or tingling in the fingers.

Primary versus secondary

The encyclopedia separates Raynaud disease, which occurs on its own and most often begins in women younger than 30, from secondary Raynaud phenomenon, which is linked to other conditions and can occur at any age. People with the primary type tend to have problems in the same fingers on both sides. Secondary Raynaud is more worrying, because painful ulcers may form on the fingers if attacks are severe. The distinction is the main reason a provider looks for any underlying condition.

Conditions and exposures behind secondary Raynaud

MedlinePlus lists diseases of the arteries, arthritis and autoimmune conditions such as scleroderma, Sjogren syndrome, rheumatoid arthritis, vasculitis and lupus, some blood disorders, repeated injury or heavy use of vibrating machines, smoking, frostbite and thoracic outlet syndrome. Certain medicines that narrow arteries are also named, including amphetamines, some beta-blockers, some cancer medicines and some migraine medicines. Circulation in the legs is the subject of the peripheral artery disease guide, and tingling is covered in the numbness and tingling guide.

How it is diagnosed

A provider can often identify the condition behind Raynaud by asking questions and doing a physical exam. MedlinePlus lists tests that may confirm the diagnosis, including a close look at the tiny blood vessels at the base of the fingernails using a special lens, vascular ultrasound and blood tests for arthritic and autoimmune conditions. The nailfold study and ultrasound are specialist tests, while blood work is on this practice's list. The complete blood count guide explains one common blood test that is part of such a work-up.

Keeping warm, and what else helps

MedlinePlus recommends keeping the affected body part warm, wearing mittens or gloves outdoors and when handling ice or frozen food, and avoiding getting chilled after active recreation. It advises stopping smoking, because smoking narrows blood vessels further, avoiding caffeine and avoiding medicines that tighten blood vessels, and wearing roomy shoes and wool socks. Prescription medicines to relax blood vessel walls and low-dose aspirin are sometimes used. The quitting smoking guide explains how a provider can help with the hardest step.

When to contact a provider

MedlinePlus says to contact your provider if the affected part becomes infected or develops a sore, if your fingers change color and do not return to normal when warmed, if your fingers or toes turn black or the skin breaks down, or if you have a sore on the hands or feet that does not heal. Fever, swollen or painful joints or skin rashes with Raynaud are also reasons to call. Complications can include gangrene or ulcers if an artery becomes blocked, which is why color changes that do not recover are urgent.

Sources

• MedlinePlus — Raynaud phenomenon