RAYNAUD PHENOMENON
Raynaud phenomenon (RP) is a syndrome of paroxysmal digital ischemia, mostly caused by exaggerated response of digital arterioles to cold or emotional stress.
Initially Raynaud phenomenon mediated by excessive vasoconstriction, mainly consists of well demarcated digital pallor or cyanosis. The recovery of Raynaud phenomenon may be done by vasodilation which leads to intense hyperemia and rubor.
Raynaud phenomenon mostly affects fingers and also affects toes and other acral areas like ears and nose. Raynaud phenomenon is divides in two categories like primary(Raynaud disease) and secondary. Primary Raynaud phenomenon occurs in 2-7% of adults and especially in young women. Secondary Raynaud phenomenon is less common and it is associated with rheumatic diseases like scleroderma.
Primary RP is appears always in women of 15-30 age. It is mild progressive and symmetric involvement of fingers of both hands. Spasm become more frequent and prolonged.
In secondary RP, the nailfold capillary abnormalities are diagnosed. The nailfold capillary pattern can be visualized by placing a drop of grade B immersion oil at the patient cuticle and then viewing the area with an ophthalmoscope. Dropout of capillary and dilation of remaining capillary loops indicate that the person has a secondary RP, most commonly scleroderma. Digital pitting or ulceration and other abnormal physical findings like rash, swollen joints, loss of extremity pulse and skin tightening can also take as a evidence of secondary RP. Secondary RP is unilateral and involve only one or two fingers.
Raynaud phenomenon is likely first manifestation of limited scleroderma (CREST syndrome). The diagnosis of many of these rheumatic disease can be confirmed with specific serologic tests.
RP is may occur in patients with the thoracic outlet syndrome. Carpal tunnel syndrome should be considered and nerve conduction tests are appropriate in selected cases.
Primary RP is benign and largely a nuisance for affected persons who are exposed to cold winters or excessive air conditioning.
TREATMENT
Initial therapy is to keep body warm and should wear gloves or mittens whenever outside in temperature that precipitate attacks. Wearing warm shirts, coats and hats will help in preventing the exaggerated vasospasm that causes Raynaud phenomenon. The hand should be protected from injury at all the times, wound heal slowly, and infection is hard to control.
Lubricating and softening lotion is applied to the hands frequently to control fissured dry skin. Quitting of smoking is advisable and decongestants or amphetamines must be avoided.
Calcium channel blocker are first line treatment for Raynaud phenomenon because it is more effective in primary RP than secondary RP. Nifedipine, amlodipine, isradipine, felodipine, and nisoldipine are very effective and popular in medication of RP.
Other medication are also effective in treating Raynaud phenomenon is sympatholytic agents, angiotensin converting enzyme inhibitor, statins, parenteral or oral prostaglandins, Serotonin reuptake inhibitors, topical nitrates, Phosphodiesterase enzyme inhibitor, and endothelin receptors inhibitors.
When attacks have become more severe and they interfere with work or well being and when trophic changes have developed and medication failed then Sympathectomy may be done. Digital sympathectomy may improve secondary Raynaud phenomenon.
For Informational purpose only. Consult your Physician for advice.
