Unifying Concepts

Diagnostic Criteria for Primary Raynaud’s Phenomenon (RP)

Raynaud’s phenomenon (RP), is a disorder of the microvasculature that generally affects the fingers and toes but can present on other extremities such as the nose, ears and nipples.

Diagnostic Criteria for Primary Raynaud’s Phenomenon

  • Meets 3 Step Criteria for diagnosis of Raynaud’s phenomenon
  • Normal Capillaroscopy (e.g. clusters 1 and 2, which were described as “normal” and “perfect normal”)
  • Physical examination is negative for findings suggestive of secondary causes, (e.g.ulcerations, tissue necrosis or gangrene, sclerodactyly, calcinosis, or skin fibrosis)
  • No history of existing connective tissue disease
  • Negative OR low titer ANA (e.g. 1:40 by indirect immunofluorescence)


Three-step approach to diagnosis of Raynaud’s Phenomenon

Step 1: Ask screening Question
Are your fingers unusually sensitive to cold?
Yes, proceed to step 2

Step 2: Assess color changes
Occurrence of biphasic color changes during the vasospastic episodes (white and blue)
Yes, proceed to step 3

Step 3: Calculate disease score

  1. Episodes are triggered by things other than cold (i.e. emotional stressors)
  2. Episodes involve both hands, even if the involvement is asynchronous and/or asymmetric
  3. Episodes are accompanied by numbness and/or paresthesias
  4. Observed color changes are often characterized by a well-demarcated border between affected and unaffected skin.
  5. Patient provided photograph(s) strongly support a diagnosis of RP.
  6. Episodes sometimes occur at other body sites (e.g. nose, ears, feet, and areolas).
  7. Occurrence of triphasic color changes during the vasospastic episodes (white, blue, red)

If 3 or more criteria met from Step 3 (a – g), then the patient has RP



  1. Stringer T, Femia AN. Raynaud’s phenomenon: Current concepts. Clin Dermatol. 2018 Jul – Aug;36(4):498-507. [Medline]
  2. Maverakis E, Patel F, Kronenberg DG, Chung L, Fiorentino D, Allanore Y, Guiducci S, Hesselstrand R, Hummers LK, Duong C, Kahaleh B, Macgregor A, Matucci-Cerinic M, Wollheim FA, Mayes MD, Gershwin ME. International consensus criteria for the diagnosis of Raynaud’s phenomenon. J Autoimmun. 2014 Feb-Mar;48-49:60-5. [Medline]


Created Aug 15, 2019.

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