MS. J, 30, IS A HAIR STYLIST who owns a small salon. Recently, she' s been experiencing episodic attacks of cold fingers of both hands associated with sharply demarcated skin pallor (white attack). It usually begins in one of her index fingers and spreads to her middle and ring fingers symmetrically in both hands. The pallor, which lasts for several minutes, is followed by cyanosis (blue attack), then by erythema with "a painful burning sensation." Ms. J' s attacks occur suddenly following exposure to cold temperatures, and her hands don't return to normal for up to several hours. 1 During these attacks, she can't use her hands skillfully or precisely, which inconveniences her customers and hurts her business.In an attempt to rewarm her hands so she can resume working, Ms. J rubs them together, holds them under warm running water, and places them under her axillae. Ms. J is very concerned that these attacks could be caused by a serious disease that may permanently damage her hands, leaving her unable to work. Because of her concerns, Ms. J hasn't been sleeping well and has increased her cigarette smoking from ½ pack to 1 pack per day.