Raynaud’s disease and phenomenon

Raynaud’s disease and phenomenon

Definition

An exaggerated vascular response to cold, causing a spasm of the arteries supplying the fingers and toes.

Prevalence

Five to ten per cent of young women in temperate climates.

Age

Most common in 15–30 years.

Sex

F > M

Clinical features

Symptoms are symmetrical with fingers affected more than toes, it usually begins in a single digit and then becomes more generalised. There is initial skin pallor due to vasoconstriction progressing through cyanosis to hyperaemia (white to blue to red). There may be tingling or pain in the affected digits especially with restoration of blood supply during rewarming.

Investigations

Primary Raynaud’s phenomenon must be distinguished from Raynaud’s syndrome occurring with connective tis-sue disorders such as systemic sclerosis.

Management

Often avoidance of cold is all that is required. In more severe cases calcium channel blockers such as nifedipine are used. In severe cases prostacyclin infusions may be required.