Secondary Raynaud's is diagnosed given the presence of an underlying condition and is associated with an older age of onset.

[3] In comparison to primary Raynaud's, episodes are more likely to be painful, asymmetric and progress to digital ulcerations.

[7] Secondary Raynaud's can occur due to a connective-tissue disorder such as scleroderma or lupus, injuries to the hands, prolonged vibration, smoking, thyroid problems, and certain medications, such as birth control pills and stimulants.

[3] Severe disease may in rare cases lead to complications, specifically skin sores or gangrene.

These events are episodic, and when the episode subsides or the area is warmed, the blood flow returns and the skin color first turns red (rubor), and then back to normal, often accompanied by swelling, tingling, and a painful "pins and needles" sensation.

[10] In a large genetic study two genes were identified that predispose for the condition: ADRA2A (alpha-2A-adrenergic receptor for adrenaline) and the transcription factor IRX1.

Caffeine, estrogen, and nonselective beta-blockers are often listed as aggravating factors, but evidence that they should be avoided is not solid.

Raynaud's phenomenon is the initial symptom that presents for 70% of patients with scleroderma, a skin and joint disease.

In the secondary type, normal activity of blood vessels is disrupted due to the same reasons mentioned above causing vasoconstriction which leads to ischemia and tissue death.

Nail fold capillary examination or "capillaroscopy" is one of the most sensitive methods to diagnose RS with connective tissue disorders, i.e. distinguish a secondary from a primary form objectively.

[26] Recently, International Consensus Criteria were developed for the diagnosis of primary Raynaud's phenomenon by a panel of experts in the fields of rheumatology and dermatology.

[26] Secondary Raynaud's is managed primarily by treating the underlying cause, and as primary Raynaud's, avoiding triggers, such as cold, emotional and environmental stress, vibrations, and repetitive motions, and avoiding smoking (including passive smoking) and sympathomimetic drugs.

The prognosis of secondary Raynaud is related to the course of the underlying disease, and how effective blood flow-restoring maneuvers are.