Private raynaud's clinic in London, same-day GP.

The colour changes

Classically three phases, though not everyone gets all of them: white as blood flow shuts down, then blue as oxygen is used up, then red on rewarming as blood floods back, often with throbbing, tingling and pain. Episodes last minutes to hours. Colour change may be harder to see on darker skin — look for pallor of the nail beds and rely on the numbness and pain.

Primary or secondary

• Primary — the great majority. Usually starts in the teens or twenties, affects both hands symmetrically, is triggered by cold and stress, and causes no tissue damage. Often runs in families and is commoner in women.
• Secondary — caused by an underlying condition, most often scleroderma, lupus, Sjögren's, rheumatoid arthritis or vasculitis. Suggested by later onset, asymmetry, severe episodes, ulceration, and other symptoms.
• Also secondary to vibrating tools (hand-arm vibration syndrome, which is reportable at work), certain medicines including beta-blockers and some migraine treatments, smoking, and thoracic outlet compression.

Managing it

Treatment

• Nifedipine is the usual first-line medicine, taken through the winter or year-round. Headache, flushing and ankle swelling are common early and often settle.
• Other options include alternative calcium channel blockers, and specialist treatments for severe secondary Raynaud's.
• Treat any underlying condition — that is where the real benefit lies in secondary Raynaud's.
• Ulcers need prompt specialist management.