Diagnosis: Suspect Raynaud's phenomenon if there is cold- or stress-induced episodic vasospasm of arteries in the digits leading to clearly demarcated blanching, followed by cyanosis and/or erythema. Typical symptoms include symmetrical involvement, reversible episodes, and colour changes starting at the fingertip. Differentiate primary from secondary Raynaud's by age at onset, symptoms severity, symmetry, and presence of underlying conditions such as connective tissue disease. Assessment should include history of symptoms, triggers, impact on function, and examination of digits, skin, nails, and peripheral pulses. Blood tests including full blood count, inflammatory markers, thyroid function, and ANA titres should be arranged to identify secondary causes NICE CKS.
Management: Primary Raynaud's is usually mild and symmetrical, requiring education on avoiding triggers such as cold and smoking. Secondary Raynaud's requires referral to rheumatology for underlying diseases or if frequent, severe episodes or complications like digital ischemia occur. Urgent referral or hospital admission is indicated if there are signs of critical ischemia, severe ulceration, or infection. Paediatric referral is appropriate for children under 13 or if drug treatment is being considered in young people NICE CKS.