What are the other Names for this Condition? (Also known as/Synonyms)

• Secondary Raynaud’s Disease
• Secondary Raynaud’s Phenomenon
• Secondary Raynaud's Syndrome

What is Secondary Raynaud Phenomenon? (Definition/Background Information)

• Raynaud phenomenon is a condition wherein there is abnormal constriction of the arteries causing episodes of decreased blood flow in the body. The condition usually affects the extremities, especially the hands/fingers. The mechanism of development of Raynaud phenomenon is not well-understood
• Secondary Raynaud Phenomenon is a type of Raynaud phenomenon that arises due to underlying factors/conditions such as certain blood disorders, use of some medication, occupations, and trauma
• The condition can present pale (whitish) areas on the fingers and hands, which then turn bluish, and subsequently red, due to changing blood flow to the affected skin . This can result in burning sensation, inflammation, and pain 
• Blood tests, imaging studies, and a tissue biopsy may be necessary to diagnose the underlying condition associated with Secondary Raynaud Phenomenon. In many individuals, treating the underlying condition adequately may help resolve Raynaud phenomenon
• The treatment measures may include use of medication, stress therapy, and avoidance of cold conditions. However, the prognosis of secondary Raynaud Phenomenon is based on the associated condition and its severity

Who gets Secondary Raynaud Phenomenon? (Age and Sex Distribution)

• Secondary Raynaud Phenomenon is more common among older adults, although individuals of any age group are at risk
• Generally, females are affected more than males
• No racial or ethnic group predilection is reported. The condition is observed worldwide

What are the Risk Factors for Secondary Raynaud Phenomenon? (Predisposing Factors)

The risk factors for Secondary Raynaud Phenomenon may include a variety of conditions such as:

• Living in cold temperatures; participating in outdoor activities during cold winters
• Infections such as Lyme disease
• Anorexia nervosa, eating disorder
• Connective tissue disorders such as Ehlers-Danlos syndrome, Sjögren's syndrome, systemic lupus erythematosus, rheumatoid arthritis, etc.
• Obstructive disorders including atherosclerosis, thoracic outlet syndrome, Takayasu’s arteritis, etc.
• Use of certain medications, such as beta-blockers, antibiotics, stimulants, chemotherapy agents, etc.
• Using any construction machine or tool that causes vibration, such as a jackhammers, pile drivers, excavators, and impactors
• Trauma to the hands or feet, such as due to accidents or frostbite
• A variety of cancers
• Certain blood disorders
• Emotional and psychological stress

The following factors may worsen the symptoms of Raynaud phenomenon:

• Cold temperatures
• Smoking; caffeinated drinks
• Estrogen therapy

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Secondary Raynaud Phenomenon? (Etiology)

• Secondary Raynaud Phenomenon is a benign condition that occurs due to the temporary, variable narrowing of arteries, resulting in decreased blood flow to the fingers and toes. When factors leading to the causation of the condition are known, it is called Secondary Raynaud Phenomenon
• This may be from a variety of conditions including connective tissue disorders, certain occupations, stress, use of several medications, and certain lifestyle factors

What are the Signs and Symptoms of Secondary Raynaud Phenomenon?

The signs and symptoms of Secondary Raynaud Phenomenon may vary from one individual to another. It may also be mild or severe. The signs and symptoms may include:

• Initially, there is decrease in blood flow resulting in pale areas, which may be associated with pain or numbness
• Bluish to purple discoloration may be observed from a lack of oxygen to the region/skin
• Subsequently, the blood vessels dilate in the affected region resulting in increased oxygenated blood flow causing redness, burning sensation, pain, tingling sensation, and swelling
• Usually, such episodes are triggered by exposure to cold, and such episodes can last from several minutes to several hours
• The condition usually affects the fingers, hands, feet, and toes. Occasionally, it can affect parts of the face such as the ears, lips, and nose
• Occasionally, it can affect in the nipples in a breastfeeding mother, resulting in a very painful condition
• Some individuals may have migraine headaches and chest pain
• Signs and symptoms from an underlying condition, if present

How is Secondary Raynaud Phenomenon Diagnosed?

Secondary Raynaud Phenomenon may be diagnosed using the following tests and exams:

• Complete physical examination with comprehensive evaluation of medical history
• Assessment of the signs and symptoms
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Blood tests that include:
  • Complete blood count (CBC)
  • Serum electrolyte levels
  • C-reactive protein levels test
  • Erythrocyte sedimentation rate (ESR) test
  • Rheumatoid factor levels blood test
  • Urine analysis
  • Thyroid function test
  • Kidney function test
• Imaging studies such as:
  • Doppler ultrasound studies to determine blood flow
  • Radiographic studies of the affected region, if needed
• Pulse oximetry, to determine the level of oxygen in blood
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Secondary Raynaud Phenomenon?

The following complications may be noted from Secondary Raynaud Phenomenon:

• Cosmetic issues resulting in emotional stress
• Ulcerations at the tips of fingers, with very slow healing
• Secondary bacterial and fungal infection due to scratching, bleeding, and ulceration
• Complications arising from an underlying disorder, if any

How is Secondary Raynaud Phenomenon Treated?

The following measures may be considered in treating Secondary Raynaud Phenomenon:

• Undertaking treatment of the underlying condition/disorder
• Avoidance of cold conditions and cold weather; wearing protective (warm) clothing
• Avoiding the triggers causing the condition
• Psychological counseling for stress; cognitive behavioral therapy including the use of antidepressants and anti-anxiety medications, if necessary
• Medication to block the abnormal narrowing of the blood vessels
• Nitroglycerin gel applied to the fingers to dilate the arterioles
• In rare cases, if the symptoms are severe, a surgical procedure called sympathectomy can be performed. It is important to note that this surgery is not performed in a vast majority of individuals
• Oral vasodilation medications, particularly nifedipine
• Symptomatic and supportive therapy, as necessary

How can Secondary Raynaud Phenomenon be Prevented?

Current medical research has not established a method of preventing Secondary Raynaud Phenomenon. However, the following measures may be considered to help lower one’s risk for the condition:

• Avoiding exposure to cold weather and cold temperatures; use protective and warm clothing
• Undertaking early diagnosis and treatment of any associated condition may be beneficial
• Inform your physician if you are allergic to any medication
• Managing stress, modifying certain lifestyle factors such as avoiding smoking
• Stopping or avoiding activities that trigger the condition
• Changing work activities to avoid using vibratory equipment, when possible

What is the Prognosis of Secondary Raynaud Phenomenon? (Outcomes/Resolutions)

• The prognosis of Secondary Raynaud Phenomenon is based on the severity of the underlying condition it is associated with
• Individuals with mild conditions have better prognosis than those with severe symptoms due to an underlying disorder

Additional and Relevant Useful Information for Secondary Raynaud Phenomenon:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/health-topics/vein-and-vascular-center/