Signs and Symptoms
The manifestation of an episode of Raynaud’s phenomenon typically comprises changes in skin color that occur in a characteristic “triphasic” pattern: white, blue, and red (Baumhakel 2010; Cooke 2005; Herrick 2012; Stewart 2012). In the initial phase, decreased blood flow as a result of vasoconstriction (known as ischemia) causes the skin to turn white (Goundry 2012). This is followed by a blue phase (known as the cyanotic phase), which is caused by poor oxygenation of the area (Goundry 2012). The third phase is characterized by redness, as blood flow to the area is restored (Cooke 2005; Goundry 2012; Herrick 2012). When the area becomes white, a sensation of numbness occurs, frequently accompanied by tingling. When the skin becomes red, the area becomes warm and painful (Stewart 2012). All three phases are not required for a diagnosis to be made (Goundry 2012). Raynaud’s phenomenon attacks sometimes affect only one or two fingers or toes, and they do not have to involve the same fingers or toes at every attack (Mayo Clinic 2011c).
Primary Raynaud’s Phenomenon
In most people with primary Raynaud’s phenomenon, signs and symptoms develop between ages 15 and 40 (Planchon 1994; NIAMS 2009; Stewart 2012). A study that enrolled over 3000 patients with primary Raynaud’s phenomenon reported that its appearance before age 40 was not significantly associated with connective tissue disorders, while its appearance after age 40 was significantly associated with connective tissue disorders. In addition, patients whose primary Raynaud’s phenomenon worsened over time were at higher risk for later developing connective tissue disorders (Pavlov-Dolijanovic 2012).
Although relatively rare in primary Raynaud’s phenomenon, ulcers may develop in the affected area due to lack of blood flow. The development of ulcers, scarring, and gangrene is more common in secondary Raynaud’s phenomenon (Cooke 2005; Stewart 2012).
Secondary Raynaud’s Phenomenon
Secondary Raynaud’s phenomenon usually starts after age 35–40 (NIAMS 2009). This form, in which an underlying disease exists, can result in more serious signs and symptoms, including painful ulcers and dead tissue (gangrene) in the affected extremity; this can lead to loss of the affected digit in severe cases (Stewart 2012).