Raynaud's Phenomena

Diagnosis: Raynaud's Phenomena

Raynaud's Phenomena

Clinical Presentation

Raynaud's Phenomena

Clinical History

Episodic digital color changes (white → blue → red) triggered by cold or stress. Assess for underlying CTD (ANA, nailfold capillaroscopy). Digital ulcers suggest secondary Raynaud.

Treatment

Cold avoidance, smoking cessation, hand warmers. Calcium channel blockers (nifedipine, amlodipine) — first-line. PDE5 inhibitors (sildenafil). Severe: IV prostacyclin. Digital ulcers: bosentan.

Differential Diagnosis

• Peripheral arterial disease • Acrocyanosis • Chilblains (pernio) • Thoracic outlet syndrome • Complex regional pain syndrome • Buerger disease • Cryoglobulinemia

Key Learnings

• Episodic vasospasm of digital arteries — classic triphasic color change: white → blue → red • Primary Raynaud (Raynaud disease): benign, bilateral, symmetric, no tissue damage — young women • Secondary Raynaud (Raynaud phenomenon): associated with underlying CTD — especially systemic sclerosis • Nailfold capillaroscopy is key to differentiating primary from secondary • Red flags for secondary: asymmetric attacks, digital ulcers/gangrene, onset after 30, abnormal nailfold capillaries, positive ANA/anti-Scl-70 • Cold avoidance and vasodilators are cornerstone of treatment

Tags: dermatology, kodachrome