Supplementary Material for: A Blue Finger, Severe Cyanosis of Raynaud's Phenomenon with Hand-Arm Vibration Syndrome: A Case Report

Introduction: Raynaud’s phenomenon (RP) can be classified as either primary or secondary, and is traditionally characterized by triphasic color changes, including white/ischemia (blanching), blue/cyanosis, and red/hyperemia. Secondary RP, resulting from the use of handheld vibrating tools, is also referred to as vibration white finger. Blanching typically occurs in the fingertips; however, there are no documented cases of severe bilateral cyanosis associated with hand-arm vibration syndrome (HAVS). Case Presentation: A 69-year-old male with a 40-year history of using vibrating tools such as chainsaws, picks, and vibrators presented with symptoms of coldness, burning, and numbness. Photographs of the RP were taken during the winter after the patient had been outdoors without adequate warm clothing or gloves. The images depict blanching and cyanosis in all five fingers of both the hands. In this case, nailfold capillaroscopy did not reveal any structural changes such as reduced capillary density, capillary enlargement, or neovascularization, but showed minor bleeding. At the 2-year follow-up, finger skin temperature, assessed using cold-water immersion testing, showed no improvement. Conclusion: This was a rare case of extensive blanching followed by cyanosis. Clinicians should consider a history of vibrating tool use when evaluating patients with blue fingers. This case enhances our understanding of RP and HAVS and offers insights into occupational health practices for individuals using hand-arm vibratory tools.