Radiographs may show early bony changes. Duration is usually 3 months from onset of symptoms. Some patients stay in one stage or another many months or even years. They may never progress or may progress quickly to late stage. Stage II or established RSDS Edematous tissue becomes indurated.
Skin becomes cool and hyperhidrotic with livedo reticularis or cyanosis.
Hair may be lost and nails become ridged, cracked, and brittle. Hand dryness becomes prominent and atrophy of skin and subcutaneous tissues becomes noticeable. Pain remains the dominant feature. It usually is constant and is increased by any stimulus to the affected area. Stiffness develops at this stage.