Raynaud phenomenon (RP) is common, affecting between 3% and 5% of the population.
The diagnosis is made clinically: digits turn white (pallor) then blue with deoxygenation and/or red with reperfusion; pallor is well demarcated.
Primary RP often needs no pharmacologic treatment. Keeping warm, smoking cessation, regular exercise, and avoiding stress are recommended.
Secondary RP can be severe, especially when associated with scleroderma. Other connective tissue diseases, malignancy, and atherosclerosis may also be the underlying cause.
In secondary RP, calcium-channel blockers, angiotensin receptor antagonists, ACE inhibitors, SSRIs, systemic and topical nitrates, phosphodiesterase-5 inhibitors, and prostacyclins are potential treatment options.
Complications in secondary RP include severe digital ischemia, gangrene, digital ulcers, and infection.
Pain relief may be an important adjunctive treatment. There are few data for complementary therapies.
Raynaud phenomenon (RP) is characterized by vasospasm that causes digits to change color to white (pallor) from lack of blood flow, usually brought on by cold temperatures. Affected areas subsequently turn blue due to deoxygenation and/or red due to reperfusion. It can be a painful condition and can lead to complications.
History and exam
Key diagnostic factors
- digit pain/discomfort
- digital paresthesia
- pallor of digits
- red and/or blue discoloration of digits
- dilated capillaries at nailbeds
- well-defined discoloration
- magnification of nailbeds
Other diagnostic factors
- puffy hands
- tight skin
- oral/nasal ulcers
- butterfly rash
- pleuritic chest pain
- digital ulcers
- digital pits
- digital tuft resorption
- gangrene of fingertip/finger
- raised painful red lesions on finger tips
- family history
- connective tissue disease
- vibration injury
- Buerger disease
- prolonged cold exposure/frostbite
- colder climate
1st investigations to order
- clinical diagnosis
- antinuclear antibody
- erythrocyte sedimentation rate
severe secondary RP: critical ischemia with digital ulcers or threatened digital loss
primary or mild secondary RP
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