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JAMA Dermatol. 2015;151(12):1400. doi:10.1001/jamadermatol.2015.0916.

RP is triggered by cold temperatures or emotional stress and happens more often among women. There is reduced blood flow to the fingers and toes (the “digits”). Primary RP occurs on its own without an associated medical reason. Secondary RP occurs because of an underlying medical condition, such as autoimmune diseases, physical abnormalities (such as an extra rib that squeezes the blood vessels in the arms), environmental causes, blood disorders, and certain medications.

Symptoms

Both primary and secondary RP cause skin discoloration in the digits, which first turn pale and white. They then turn blue or dusky because of the decreased oxygen supply, followed by red once the blood flow returns. This can be painful or cause numbness, tingling, or throbbing.

Primary and secondary RP can usually be distinguished by their symptoms. While primary RP often occurs in people younger than 30 years and causes minimal pain, secondary RP occurs in people who are 30 years or older and is more painful. Primary RP is much more common. Secondary RP can have a more severe course that sometimes leads to skin sores and even gangrene (tissue death).

Diagnosis

Your doctor will ask you about your symptoms, look at your fingers and toes, and may use a magnifying tool called a dermoscope to look at the blood vessels surrounding your nails. Your doctor may also take blood tests to look for evidence of an underlying disease.

Treatment

Treatment of RP depends on the severity of the symptoms and the presence of underlying disease. Primary RP is not usually harmful and is therefore managed with lifestyle modifications, which include avoiding cold exposure (keeping the whole body warm is important), protecting and insulating the skin in cold climates, quitting smoking, stopping medications that cause blood vessel constriction, avoiding caffeine, and exercises to improve blood flow to the digits (such as swinging the arm with the arm straight out).

Secondary RP often requires medications that specifically treat the underlying condition. Depending on the cause of the RP, your doctor may also prescribe topical or oral medications that enhance blood flow to affected areas. Alternate therapies are available for difficult cases.