Raynaud’s syndrome is where digits turn cold, white and numb transiently, usually triggered by the cold but more particularly by cold, wet weather. Can be painful and disabling.

Severe with ischaemia (ulcers, atrophy) likely to be part of a broader rheumatological syndrome.

Prevention mostly. Smoking and cocaine likely to worsen. Moisturise dry skin!

Avoid injury while numb!

Differentiate from acrocyanosis (sluggish peripheral circulation, asymptomatic, common in young children), vibration white finger, perniosis (chilblains), cervical rib, subclavian steal.

Investigations are for underlying causes, namely connective tissue disorder (especially scleroderma in adults), vasculitis, malignancy. So if unusually severe and/or atypical:

• Full blood count
• ANA, rheumatoid factor, antiphospholipid antibodies
• Complement levels
• Protein electrophoresis
• Cold agglutinins and, in children, cryoglobulins. You don’t expect distal pallor, just blueness.

Nifedipine has most evidence to support use, other calcium channel blockers could be considered. Main side effect is low blood pressure.

Some evidence for diltiazem. Other options losartan, GTN patch, fluoxetine, alpha blockers.

For severe, sildenafil and atorvastatin! No evidence for aspirin but makes sense…