Snapshot A 50-year-old man presents to his physician’s office for discolored fingers. He reports that this happens in the cold or when he is emotionally stressed. As he is going through a divorce, he reports this happening more often than not. He reports that there is no pain, but he sometimes feels tightening in his fingers with the discoloration. He has a past medical history of limited scleroderma as well as a family history of Raynaud phenomenon. His physical exam is notable for blue fingertips. He is prescribed a calcium channel blocker for his symptoms. Introduction Clinical definition discoloration in extremities due to exaggerated physiologic response to cold temperatures or emotional stress classification login to view 4 more bullets Pathogenesis ↓ blood flow to skin due to exaggerated physiologic response to cold temperatures or emotional stress login to view 1 more bullet phases login to view 3 more bullets Associated conditions systemic sclerosis or limited scleroderma systemic lupus erythematosus mixed connective tissue disease cryoglobulinemia thromboangiitis obliterans (Buerger disease) juvenile rheumatoid arthritis Epidemiology Demographics Raynaud disease login to view 3 more bullets Raynaud syndrome login to view 1 more bullet Location fingers > toes Risk factors family history autoimmune disease Etiology cold temperatures emotional stress drugs beta blockers Presentation Symptoms attacks of triphasic color changes in extremities with cold temperatures or emotional stress login to view 2 more bullets Physical exam may not present with all 3 phases usually in fingers or toes, but can also affect nose, cheeks, or ears may have faint peripheral pulses may have digital ischemia, but this is uncommon login to view 2 more bullets Studies Labs only indicated if an underlying disease is suspected Making the diagnosis most cases are clinically diagnosed can use cold stimulation test to trigger an attack login to view 1 more bullet Differential Thromboangiitis obliterans (Buerger disease) distinguishing factor login to view 1 more bullet Frostbite distinguishing factors login to view 2 more bullets Treatment Conservative avoid cold temperatures login to view 4 more bullets smoking cessation login to view 2 more bullets Medical dihydropyridine-type calcium channel blockers login to view 5 more bullets phosphodiesterase inhibitors login to view 4 more bullets Complications Digital ulceration more common with secondary Raynaud syndrome