How Do You Stop a Raynaud's Attack in Scleroderma?

Managing Raynaud’s phenomenon in scleroderma often requires more than just prescription medications like calcium channel blockers. Daily attacks where fingers turn white, freeze, and become painful are a significant nuisance, but practical, non-drug strategies can help. The most effective lifestyle interventions involve keeping your body’s core warm, actively avoiding cold and chemical triggers, managing stress, and using physical maneuvers to restore blood flow during an attack ^[1][2].

Preventing Attacks Before They Start

Focus on Core Warming, Not Just Your Hands
When you are exposed to cold, your body naturally pulls blood away from your extremities to protect your vital organs. Because of this, simply putting on winter accessories on your hands is often not enough. Keeping your physical core warm with layers, such as insulated vests, is a critical first-line strategy ^[1]. Additionally, research shows that actively heating the upper arms and elbows helps maintain overall blood vessel dilation, which significantly reduces the frequency and duration of vasospastic attacks in the hands ^[3]. Drinking warm beverages like tea or hot water can also help raise your core body temperature from the inside out.

Anticipate and Avoid Cold Triggers
Cold exposure is the primary trigger for Raynaud’s attacks, but sudden changes in temperature are often more problematic than the absolute temperature ^[4]. This means you must anticipate “hidden” cold traps in your daily life.

• Wear mittens, not gloves: Gloves isolate each finger, which can keep them cold. Mittens are vastly superior because they allow your fingers to share body heat.
• Avoid the freezer aisle: The sudden drop in temperature when reaching into grocery store freezers is a common trigger. Wear mittens specifically for shopping or have someone else grab frozen items. A practical tip: Keep a dedicated pair of mittens sitting on top of or next to your refrigerator at home, as the home fridge is just as much of a daily trigger.
• Beware of air conditioning: Overly air-conditioned environments during the summer can easily trigger attacks ^[4][2]. Keep a sweater or vest handy even in warm weather.

Manage Emotional Stress Triggers
Raynaud’s is a vasospastic condition (where blood vessels suddenly spasm and narrow), triggered not only by cold but also by emotional stress and anxiety ^[5]. The “fight or flight” response constricts blood vessels. Anxiety management and stress reduction techniques are recognized as essential components of a stepped-care approach to managing Raynaud’s symptoms ^[6][1]. When an unexpected attack hits due to stress, trying a quick grounding technique like box breathing (inhale for 4 seconds, hold for 4, exhale for 4, hold for 4) can help calm your nervous system.

Avoid Chemical Triggers and Constricting Substances
Certain substances actively narrow your blood vessels and can provoke or worsen Raynaud’s attacks ^[2][7].

• Decongestants and caffeine: Over-the-counter cold medications containing decongestants (like pseudoephedrine or phenylephrine) are potent vasoconstrictors and should be strictly avoided ^[2][8]. Caffeine can also trigger spasms in some patients.
• Smoking: Smoking is a major constrictor of blood vessels. If you smoke, smoking cessation is one of the most impactful non-drug strategies to improve vascular health and reduce Raynaud’s severity ^[1].

Stopping an Active Attack

When an attack happens, the goal is to quickly reverse the blood vessel constriction and return blood to your fingers.

Use Chemical Hand Warmers (With Caution)
Having portable warmth on hand is crucial. While standard medical management emphasizes general warming, keeping chemical hand warmers in your pockets provides immediate, localized heat to help shorten the duration of an attack ^[1][9].

• Burn Warning: During an attack, your hands often go numb, making it impossible to accurately feel temperature. To avoid severe thermal burns, never place chemical hand warmers directly against bare skin, and always test temperatures with a non-numb part of your body (like your forearm) ^[10][11].

Warm Water Rescues
Running your hands under warm—but strictly not hot—water is a common and accessible rescue technique to encourage blood vessels to dilate ^[2]. Again, because of numbness, always check the water temperature with your forearm first to prevent burns ^[10].

The Windmill Technique
While much of the medical literature focuses heavily on warming techniques and medications, physical and mechanical maneuvers are also used to combat attacks ^[2][8]. One practical strategy is the “windmill” technique. This involves swinging your arms in large, rapid circles. The centrifugal force helps physically push blood back down into the fingers, temporarily overcoming the vessel spasms. Make sure you have clear physical space so you don’t hit objects, and avoid this maneuver if you have severe shoulder mobility issues.