4 Raynaud's can also affect other vascular beds including the lips, nose, ears and nipples. The majority of classification systems have traditionally mandated the presence of at least two (biphasic) colour changes. 27 Cyanosis (without blanching) has been reported to be more common in patients with SSc compared with primary RP, and reactive hyperaemia less common. It is important to highlight that patients do not need to have all three colour changes. The classical description of RP is a triad of initially white/pallor from vasoconstriction, blue/cyanosis from sequestration of deoxygenated blood and finally redness from reperfusion and hyperaemia (Fig (Fig1). Typical attacks of RP consist of episodic colour change of the hands and often the feet triggered by exposure to cold temperature and/or emotional stress. Future research is needed to understand the complex pathogenesis of RP and to measure the impact and severity of RP to develop optimised approaches to management. There are a wide range of available drug therapies to treat RP, including when complicated by digital ulceration, and surgical intervention is sometimes required. Non-pharmacological management is indicated in all patients. Patients require a comprehensive clinical assessment and investigation, in particular, the detection of autoantibodies and nailfold capillaroscopic abnormalities. Unlike primary RP, patients with secondary RP can develop persistent digital ischaemia, including ulcers and gangrene. RP is a cardinal feature in patients with systemic sclerosis and is often the earliest symptom of the disease. The majority of individuals have primary RP however, Raynaud's can also occur secondary to a broad range of underlying medical conditions and drug therapies. Raynaud's phenomenon (RP) is a common vasospastic condition which affects ~5% of the general population.
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