Raynaud’s disease: Difference between revisions
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**Pharmacologic | **Pharmacologic | ||
***Oral vasodilators | ***Oral vasodilators | ||
****Nifedipine 30 to 180 mg/day | ****[[Nifedipine]] 30 to 180 mg/day | ||
****Amlodipine 5 to 20 mg/day | ****[[Amlodipine]] 5 to 20 mg/day | ||
***Topical nitrates | ***Topical nitrates | ||
***Phosphodiesterase 5 inhibitors | ***Phosphodiesterase 5 inhibitors | ||
Revision as of 20:27, 12 August 2018
Background
Exaggerated vascular response to cold or emotional stress
Clinical Features
Sharp demarcated color changes of the skin of the digits
Pain, loss of sensation, and if recurrent ischemia may cause ulcers
Differential Diagnosis
- Primary (Raynaud disease or idiopathic Raynaud Phenomenon)
- Symptoms without an associated disorder
- Secondary (associated with another illness, i.e. SLE or Scleroderma)
Evaluation
- Assess for digital ischemia
- Consider evaluation for underlying disorder
Management
Improve quality of life and prevent ischemic tissue injury
- Patient education on trigger avoidance
- Severe cases/Ischemia
- Pharmacologic
- Oral vasodilators
- Nifedipine 30 to 180 mg/day
- Amlodipine 5 to 20 mg/day
- Topical nitrates
- Phosphodiesterase 5 inhibitors
- Oral vasodilators
- Surgical sympathetic blockade
- Pharmacologic
Disposition
Patient with digital ischemia not responsive to oral or topical vasodilators may need anticoagulants, IV prostanoids, and sympathectomy