Raynaud’s disease

Background

• Exaggerated vascular response to cold or emotional stress

Clinical Features

Raynaud Phenomenon

• 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
  • Surgical sympathetic blockade

Disposition

Patient with digital ischemia not responsive to oral or topical vasodilators may need anticoagulants, IV prostanoids, and sympathectomy

See Also

• SLE
• Scleroderma