Differential Diagnosis for Red and Blanching Skin on Hands

• Single most likely diagnosis
  • Raynaud's phenomenon: This condition is characterized by a sudden and temporary narrowing of the arteries, causing the skin to turn red, white, or blue in response to cold or stress. The blanching (turning white) of the skin upon pressure or cold, followed by redness, is a hallmark of this condition.
• Other Likely diagnoses
  • Cold-induced vasospasm: Similar to Raynaud's but may not be as recurrent or severe. It involves the temporary constriction of blood vessels in response to cold, leading to paleness or redness of the skin.
  • Chilblains: A condition that occurs in response to repeated exposure to cold, causing damage to small blood vessels and resulting in red, itchy, or swollen skin.
  • Contact dermatitis: Although this typically causes more than just redness and blanching, certain irritants or allergens could potentially cause a reaction that includes these symptoms.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Frostbite: Early stages can present with redness and blanching of the skin due to the freezing of skin and underlying tissues. It's crucial to identify and treat promptly to prevent permanent damage.
  • Systemic sclerosis (scleroderma): While less common, this autoimmune disease can cause Raynaud's phenomenon as an initial symptom, leading to skin thickening and potentially serious internal organ involvement.
• Rare diagnoses
  • Erythromelalgia: A disorder characterized by burning pain, heat, and redness in the hands and feet, which could potentially cause blanching in response to certain stimuli.
  • Acrocyanosis: A condition involving the arteries that supply blood to the skin, leading to persistently cold, blue, or red hands and feet, which might blanch under pressure.