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©2013 UpToDate ® Print Email Diagnostic approach to the patient with suspected Raynaud phenomenon Patients who present with a complaint of cold sensitivity of the digits of the hands or feet and who have color changes of the skin (pallor and/or cyanosis) can be considered to have Raynaud phenomenon (RP). While patients with RP may present with asymmetry or a dominant more sensitive digit(s), patients with primary or secondary usually have involvement of all digits (relative sparing of the thumb) in a symmetrical fashion. Patients with primary RP meet diagnostic criteria including the absence of tissue ulceration, negative symptoms or physical signs of a secondary disease, normal nail fold capillaries, and negative presence of autoantibodies. Patients with secondary RP have a history of exposure to causative or aggravation factor(s) or symptoms or signs of a secondary disease process. Patients presenting with persistent asymmetrical or single digit ischemia with signs of vascular compromise mimic true RP because of associated vasospasm of involved digital vessels. In these cases, larger vessel occlusive disease or embolic disease should be considered. Courtesy of Fredrick M Wigley, MD.