History

Fact Explanation
Absence of causative factors for secondary Raynaud phenomenon There are associated vascular and non-vascular causes for secondary Raynaud phenomenon but it is not classified under Raynaud disease. [1] [2] [3] [4] [5]
Colour change of the extremities following an exposure to a stimulus Raynaud phenomenon or freezing finger syndrome is characterized by three phasic color change when challenged with a predisposing factor. First when the stimulus is applied, there is an immediate vasoconstriction causing the affected areas to appear blood-less or pale. The extent of vasoconstriction is easily visible separated. After that, since the blood flow is insufficient to keep the oxygenated blood running, the affected blood vessels become desaturated and the areas are cynosed, so they appear blue. Once the stimulus is withdrawn, the blood vessels dilate and the rapid blood flow established, causing the affected areas to look redder, or hyperemic. Skin color comes back to the natural color with time. The most commonly affected areas are the extremities. i.e. finger-tips, toe-tips, earlobes, lips and nipples. The symptoms are always bilateral. The color change may not be very visible in the dark skinned population. The color change is reversible and reproducible. The usual predisposing factors are cold and emotional upset. It is hypothesized that increased level of sympathetic activity is the causative factor in primary Raynaud syndrome. [6] [7] [8] [9] [10] [11] [12] [13]
Pain of the affected areas Due to collection of noxious metabolites in the process of ischemia. [6] [14] [15]
Numbness of the affected areas Due to sensory nerve ischemia. [6] [16] [17] [18]
References
  1. MAVERAKIS EMANUAL, PATEL FORUM, KRONENBERG DANIEL G., CHUNG LORINDA, FIORENTINO DAVID, ALLANORE YANNICK, GUIDUCCI SERENA, HESSELSTRAND ROGER, HUMMERS LAURA K., DUONG CHRIS, KAHALEH BASHAR, MACGREGOR ALEXANDER, MATUCCI-CERINIC MARCO, WOLLHEIM FRANK A., MAYES MAUREEN D., GERSHWIN M. ERIC. International consensus criteria for the diagnosis of Raynaud's phenomenon. Journal of Autoimmunity [online] 2014 February, 48-49:60-65 [viewed 05 August 2014] Available from: doi:10.1016/j.jaut.2014.01.020
  2. CHENG KS, TIWARI A, BOUTIN A, DENTON CP, BLACK CM, MORRIS R, SEIFALIAN AM, HAMILTON G. Differentiation of primary and secondary Raynaud's disease by carotid arterial stiffness. Eur J Vasc Endovasc Surg [online] 2003 Apr, 25(4):336-41 [viewed 05 August 2014] Available from: doi:10.1053/ejvs.2002.1845
  3. HIRSCHL MIRKO, HIRSCHL KATHARINA, LENZ MATTHIAS, KATZENSCHLAGER REINHOLD, HUTTER HANS-PETER, KUNDI MICHAEL. Transition from primary Raynaud's phenomenon to secondary Raynaud's phenomenon identified by diagnosis of an associated disease: Results of ten years of prospective surveillance. Arthritis Rheum [online] December, 54(6):1974-1981 [viewed 05 August 2014] Available from: doi:10.1002/art.21912
  4. ANDERS H J. Differentiation between primary and secondary Raynaud's phenomenon: a prospective study comparing nailfold capillaroscopy using an ophthalmoscope or stereomicroscope. [online] 2001 April, 60(4):407-409 [viewed 05 August 2014] Available from: doi:10.1136/ard.60.4.407
  5. CHLEBICKA I, MATUSIAK Ł, MAJ J, BARAN E, SZEPIETOWSKI J. Freezing Fingers Syndrome, Primary and Secondary Raynaud’s Phenomenon: Characteristic Features with Hand Thermography. Acta Derm Venerol [online] 2013 December, 93(4):428-432 [viewed 05 August 2014] Available from: doi:10.2340/00015555-1508
  6. COOKE JOHN P, MARSHALL JANICE M. Mechanisms of Raynaud's disease. vasc med [online] 2005 November, 10(4):293-307 [viewed 05 August 2014] Available from: doi:10.1191/1358863x05vm639ra
  7. HERRICK A. L.. Pathogenesis of Raynaud's phenomenon. Rheumatology [online] 2005 February, 44(5):587-596 [viewed 05 August 2014] Available from: doi:10.1093/rheumatology/keh552
  8. COFFMAN J. D.. Raynaud's phenomenon. An update. Hypertension [online] 1991 May, 17(5):593-602 [viewed 05 August 2014] Available from: doi:10.1161/​01.HYP.17.5.593
  9. HEIDRICH H.. Functional vascular diseases: Raynaud’s syndrome, acrocyanosis and erythromelalgia. VASA [online] December, 39(1):33-41 [viewed 05 August 2014] Available from: doi:10.1024/0301-1526/a000003
  10. ANDERSON JE, HELD N, WRIGHT K. Raynaud's phenomenon of the nipple: a treatable cause of painful breastfeeding. Pediatrics [online] 2004 Apr, 113(4):e360-4 [viewed 05 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/15060268
  11. PANCERA P, SANSONE S, PRESCIUTTINI B, MONTAGNA L, CERù S, LUNARDI C, LECHI A. Autonomic nervous system dysfunction in sclerodermic and primary Raynaud's phenomenon. Clin Sci (Lond) [online] 1999 Jan, 96(1):49-57 [viewed 05 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/9857106
  12. TURTON E. VASCULAR REVIEW The aetiology of Raynaud's phenomenon. [online] 1998 October, 6(5):431-440 [viewed 05 August 2014] Available from: doi:10.1016/S0967-2109(98)00054-4
  13. COPPO MIRELLA, BODDI MARIA, POGGESI LOREDANA, BANDINELLI MANUELA, ABBATE ROSANNA, GENSINI GIAN FRANCO. Exaggerated local hand sympathetic but not renin–angiotensin system activation in patients with primary Raynaud's phenomenon. Microvascular Research [online] 2006 March, 71(2):128-134 [viewed 05 August 2014] Available from: doi:10.1016/j.mvr.2005.12.002
  14. DEVULDER JACQUES, VAN SUIJLEKOM HANS, VAN DONGEN ROBERT, DIWAN SUDHIR, MEKHAIL NAGY, VAN KLEEF MAARTEN, HUYGEN FRANK. 25. Ischemic Pain in the Extremities and Raynaud’s Phenomenon. [online] December, 11(5):483-491 [viewed 05 August 2014] Available from: doi:10.1111/j.1533-2500.2011.00460.x
  15. LEVIEN TL. Advances in the treatment of Raynaud's phenomenon Vasc Health Risk Manag [online] 2010:167-177 [viewed 05 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2860448
  16. PETTERSSON HANS, BURSTRöM LAGE, NILSSON TOHR. Raynaud′s phenomenon among men and women with noise-induced hearing loss in relation to vibration exposure. Noise Health [online] 2014 December [viewed 05 August 2014] Available from: doi:10.4103/1463-1741.132087
  17. CHERNIACK MARTIN G.. Raynaud's Phenomenon of Occupational Origin. Arch Intern Med [online] 1990 March [viewed 05 August 2014] Available from: doi:10.1001/archinte.1990.00390150033006
  18. BENYAMIN R, KRAMER J, VALLEJO R. A case of spinal cord stimulation in Raynaud's Phenomenon: can subthreshold sensory stimulation have an effect? Pain Physician [online] 2007 May, 10(3):473-8 [viewed 05 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/17525782

Examination

Fact Explanation
Normal skin color if not stimulated The patients with Raynaud syndrome have a normal skin color unless provoked by a stimulus.
Color change if presented with a recognized stimulus. There is a triphasic color change in the extremity when met with a recognized stimulus. i.e. cold. There is a sharp demarcation between the affected areas due to the color change. [1] [2] [3] [4] [5] [6] [7]
Wounds and gangrenes There can be loss of tissues in the extremities due to chronic ischemia. Unlike in secondary Raynaud disease, in primary condition gangrenes and widespread tissue losses are rare. [9] [10] [11]
References
  1. COOKE JOHN P, MARSHALL JANICE M. Mechanisms of Raynaud's disease. vasc med [online] 2005 November, 10(4):293-307 [viewed 07 August 2014] Available from: doi:10.1191/1358863x05vm639ra
  2. COFFMAN J. D.. Raynaud's phenomenon. An update. Hypertension [online] 1991 May, 17(5):593-602 [viewed 07 August 2014] Available from: doi:10.1161/01.HYP.17.5.593
  3. MAVERAKIS EMANUAL, PATEL FORUM, KRONENBERG DANIEL G., CHUNG LORINDA, FIORENTINO DAVID, ALLANORE YANNICK, GUIDUCCI SERENA, HESSELSTRAND ROGER, HUMMERS LAURA K., DUONG CHRIS, KAHALEH BASHAR, MACGREGOR ALEXANDER, MATUCCI-CERINIC MARCO, WOLLHEIM FRANK A., MAYES MAUREEN D., GERSHWIN M. ERIC. International consensus criteria for the diagnosis of Raynaud's phenomenon. Journal of Autoimmunity [online] 2014 February, 48-49:60-65 [viewed 05 August 2014] Available from: doi:10.1016/j.jaut.2014.01.020
  4. CHLEBICKA I, MATUSIAK Ł, MAJ J, BARAN E, SZEPIETOWSKI J. Freezing Fingers Syndrome, Primary and Secondary Raynaud’s Phenomenon: Characteristic Features with Hand Thermography. Acta Derm Venerol [online] 2013 December, 93(4):428-432 [viewed 05 August 2014] Available from: doi:10.2340/00015555-1508
  5. HERRICK A. L.. Pathogenesis of Raynaud's phenomenon. Rheumatology [online] 2005 February, 44(5):587-596 [viewed 05 August 2014] Available from: doi:10.1093/rheumatology/keh552
  6. HEIDRICH H.. Functional vascular diseases: Raynaud’s syndrome, acrocyanosis and erythromelalgia. VASA [online] December, 39(1):33-41 [viewed 05 August 2014] Available from: doi:10.1024/0301-1526/a000003
  7. ANDERSON JE, HELD N, WRIGHT K. Raynaud's phenomenon of the nipple: a treatable cause of painful breastfeeding. Pediatrics [online] 2004 Apr, 113(4):e360-4 [viewed 05 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/15060268
  8. RAVINDRAN V, RAJENDRAN S. Digital gangrene in a patient with primary Raynaud’s phenomenon. J R Coll Physicians Edinb [online] 2012 March, 42(1):24-26 [viewed 07 August 2014] Available from: doi:10.4997/JRCPE.2012.106
  9. BINNETOGLU F. K., KIZILDAG B., TOPALOGLU N., KASAPCOPUR O.. Severe digital necrosis in a 4-year-old boy: primary Raynaud's or jellyfish sting. Case Reports [online] December, 2013(nov18 1):bcr2013201478-bcr2013201478 [viewed 07 August 2014] Available from: doi:10.1136/bcr-2013-201478
  10. LEVIEN TL. Advances in the treatment of Raynaud's phenomenon Vasc Health Risk Manag [online] 2010:167-177 [viewed 07 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2860448
  11. MORADINEJAD MOHAMMAD-HASSAN. Peripheral gangrene: A rare presentation of systemic lupus erythematosus in a child. Am J Case Rep [online] 2013 December, 14:337-340 [viewed 07 August 2014] Available from: doi:10.12659/AJCR.889290

Differential Diagnoses

Fact Explanation
Secondary Raynaud syndrome The causes for secondary Raynaud disease should be evaluated. i.e. Systemic Lupus Erythematosus, vasculitis, other autoimmune conditions. [1] [2] [3] [4] [5]
Occlusive arterial disorder Probable causes for occlusive arterial disease (i.e. atherosclerosis, dyslipidemia) and other co-existent manifestations (i.e. angina pectoris) should be evaluated. Occlusive arterial disease is a life threatening condition that can lead to loss of a limb unless attended to first in emergency setting. Pain, bluish discoloration of limb extremities can be initial presentation. [6] [7] [8]
Thromboembolic diseases These are the conditions where microemboli are shooted up in the systemic circulation and clogged in the end arteries of the extremities. They can manifest in the same way, with ischemia, discolored extremities. [9] [10] [11] [12] [13] [14] [15]
Reflex sympathetic dystrophy A syndrome that is caused by surgical or traumatic nerve injuries and is characterized with pain, swelling, and vasomotor dysfunction of an extremity. Careful history taking and examination can exclude this differential. [16] [17] [18] [19] [20] [21] [22]
References
  1. MAVERAKIS EMANUAL, PATEL FORUM, KRONENBERG DANIEL G., CHUNG LORINDA, FIORENTINO DAVID, ALLANORE YANNICK, GUIDUCCI SERENA, HESSELSTRAND ROGER, HUMMERS LAURA K., DUONG CHRIS, KAHALEH BASHAR, MACGREGOR ALEXANDER, MATUCCI-CERINIC MARCO, WOLLHEIM FRANK A., MAYES MAUREEN D., GERSHWIN M. ERIC. International consensus criteria for the diagnosis of Raynaud's phenomenon. Journal of Autoimmunity [online] 2014 February, 48-49:60-65 [viewed 05 August 2014] Available from: doi:10.1016/j.jaut.2014.01.020
  2. CHENG KS, TIWARI A, BOUTIN A, DENTON CP, BLACK CM, MORRIS R, SEIFALIAN AM, HAMILTON G. Differentiation of primary and secondary Raynaud's disease by carotid arterial stiffness. Eur J Vasc Endovasc Surg [online] 2003 Apr, 25(4):336-41 [viewed 05 August 2014] Available from: doi:10.1053/ejvs.2002.1845
  3. HIRSCHL MIRKO, HIRSCHL KATHARINA, LENZ MATTHIAS, KATZENSCHLAGER REINHOLD, HUTTER HANS-PETER, KUNDI MICHAEL. Transition from primary Raynaud's phenomenon to secondary Raynaud's phenomenon identified by diagnosis of an associated disease: Results of ten years of prospective surveillance. Arthritis Rheum [online] December, 54(6):1974-1981 [viewed 05 August 2014] Available from: doi:10.1002/art.21912
  4. ANDERS H J. Differentiation between primary and secondary Raynaud's phenomenon: a prospective study comparing nailfold capillaroscopy using an ophthalmoscope or stereomicroscope. [online] 2001 April, 60(4):407-409 [viewed 05 August 2014] Available from: doi:10.1136/ard.60.4.407
  5. CHLEBICKA I, MATUSIAK Ł, MAJ J, BARAN E, SZEPIETOWSKI J. Freezing Fingers Syndrome, Primary and Secondary Raynaud’s Phenomenon: Characteristic Features with Hand Thermography. Acta Derm Venerol [online] 2013 December, 93(4):428-432 [viewed 05 August 2014] Available from: doi:10.2340/00015555-1508
  6. YOUNG JR. Chronic occlusive arterial disease of the limbs. Calif Med [online] 1972 Mar, 116(3):112-113 [viewed 07 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1518293
  7. PALUMBO P. J.. Progression of Peripheral Occlusive Arterial Disease in Diabetes Mellitus. Arch Intern Med [online] 1991 April [viewed 07 August 2014] Available from: doi:10.1001/archinte.1991.00400040067015
  8. BARRETTO S., BALLMAN K. V, ROOKE T. W, KULLO I. J. Early-onset peripheral arterial occlusive disease: clinical features and determinants of disease severity and location. Vascular Medicine [online] 2003 May, 8(2):95-100 [viewed 07 August 2014] Available from: doi:10.1191/1358863x03vm475oa
  9. WAKEFIELD THOMAS W., CAPRINI JOSEPH, COMEROTA ANTHONY J.. Thromboembolic Diseases. Current Problems in Surgery [online] 2008 December, 45(12):844-899 [viewed 07 August 2014] Available from: doi:10.1067/j.cpsurg.2008.08.002
  10. KEARON CLIVE. Antithrombotic Therapy for Venous Thromboembolic Disease . Chest [online] 2008 June [viewed 07 August 2014] Available from: doi:10.1378/chest.08-0658
  11. STREIFF M. B.. Diagnosis and Initial Treatment of Venous Thromboembolism in Patients With Cancer. Journal of Clinical Oncology [online] December, 27(29):4889-4894 [viewed 07 August 2014] Available from: doi:10.1200/JCO.2009.23.5788
  12. O OLUBANIYI A, SHORT CE, REMEDIOS D, KAPEMBWA M. An unexpected cause of digital gangrene: HIV associated peripheral arterial thrombosis Br J Gen Pract [online] 2013 Mar, 63(608):162-163 [viewed 07 August 2014] Available from: doi:10.3399/bjgp13X664441
  13. RANKINE-MULLINGS ANGELA E., KNIGHT-MADDEN JENNIFER M., REID MARVIN, FERGUSON TREVOR S.. Gangrene of the digits of the right lower limb in a patient with homozygous sickle cell disease and ulcerative colitis. Clinics Pract [online] 2014 April [viewed 07 August 2014] Available from: doi:10.4081/cp.2014.610
  14. GANDHI VIJAY, SHARMA REENA, RAIZADA ALPANA, DHAWAN AMIT. Peripheral symmetrical gangrene treated with sildenafil citrate. J Cutan Aesthet Surg [online] 2012 December [viewed 07 August 2014] Available from: doi:10.4103/0974-2077.94333
  15. KAPLAN BERNARD S., GARCIA CLOTILDE D., CHESNEY RUSSELL W., SEGAR WILLIAM E., GIUGNO KATIA, CHEM ROBERTO. Peripheral gangrene complicating idiopathic and recessive hemolytic uremic syndromes. Pediatric Nephrology [online] 2000 August, 14(10-11):985-989 [viewed 07 August 2014] Available from: doi:10.1007/s004670050058
  16. OAKLANDER ANNE LOUISE, FIELDS HOWARD L.. Is reflex sympathetic dystrophy/complex regional pain syndrome type I a small-fiber neuropathy?. Ann Neurol. [online] 2009 June, 65(6):629-638 [viewed 07 August 2014] Available from: doi:10.1002/ana.21692
  17. SCHOTT G D. Nosological entities?: Reflex sympathetic dystrophy. [online] 2001 September, 71(3):291-295 [viewed 07 August 2014] Available from: doi:10.1136/jnnp.71.3.291
  18. MELLICK GARY A., MELLICK LARRY B.. Reflex sympathetic dystrophy treated with gabapentin. Archives of Physical Medicine and Rehabilitation [online] 1997 January, 78(1):98-105 [viewed 07 August 2014] Available from: doi:10.1016/S0003-9993(97)90020-4
  19. ALBAZAZ RANEEM, WONG YEW TOH, HOMER-VANNIASINKAM SHERVANTHI. Complex Regional Pain Syndrome: A Review. Annals of Vascular Surgery [online] 2008 March, 22(2):297-306 [viewed 07 August 2014] Available from: doi:10.1016/j.avsg.2007.10.006
  20. ALBAZAZ RANEEM, WONG YEW TOH, HOMER-VANNIASINKAM SHERVANTHI. Complex Regional Pain Syndrome: A Review. Annals of Vascular Surgery [online] 2008 March, 22(2):297-306 [viewed 07 August 2014] Available from: doi:10.1016/j.avsg.2007.10.006
  21. PHAM THAO, LAFFORGUE PIERRE. Reflex sympathetic dystrophy syndrome and neuromediators. Joint Bone Spine [online] 2003 February, 70(1):12-17 [viewed 07 August 2014] Available from: doi:10.1016/S1297-319X(02)00006-4
  22. BANDYK DENNIS F., JOHNSON BRAD L., KIRKPATRICK ANTHONY F., NOVOTNEY MICHAEL L., BACK MARTIN R., SCHMACHT DALE C.. Surgical sympathectomy for reflex sympathetic dystrophy syndromes. Journal of Vascular Surgery [online] 2002 February, 35(2):269-277 [viewed 07 August 2014] Available from: doi:10.1067/mva.2002.121065

Investigations - for Diagnosis

Fact Explanation
Cold challenge test It is used to test the severity of Raynaud phenomenon. The test can be performed by measuring the skin blood flow of hand or foot that is cooled or the opposite limb, to test sympathetically mediated vasoconstriction. The blood flow is assessed by laser Doppler method. The cold is applied as cold water of 20'C. [1] [2] [3]
Laser Doppler monitoring Superficial blood flow difference with cold exposure can be assessed with laser Doppler technique. It can be used in adjunct with other investigations such as cold challenge test. Serial monitoring helps in identifying the provocative stimuli. [4] [5] It is positive early in the course of the disease and Laser Doppler-recorded venoarteriolar reflex (VAR) response to hand lowering can be used to differentiate primary and secondary Raynaud phenomenon. [6] [7] [8] [9]
References
  1. CIMMINO MARCO A., GRASSI WALTER, CUTOLO MAURIZIO. Modern imaging techniques: a revolution for rheumatology practice. Best Practice & Research Clinical Rheumatology [online] 2008 December, 22(6):951-959 [viewed 07 August 2014] Available from: doi:10.1016/j.berh.2008.08.007
  2. ANDERSON M. E.. Digital iontophoresis of vasoactive substances as measured by laser Doppler imaging--a non-invasive technique by which to measure microvascular dysfunction in Raynaud's phenomenon. Rheumatology [online] 2004 June, 43(8):986-991 [viewed 07 August 2014] Available from: doi:10.1093/rheumatology/keh244
  3. HERRICK A. L, CLARK S.. Quantifying digital vascular disease in patients with primary Raynaud's phenomenon and systemic sclerosis. Annals of the Rheumatic Diseases [online] 1998 February, 57(2):70-78 [viewed 07 August 2014] Available from: doi:10.1136/ard.57.2.70
  4. PICART C, CARPENTIER PH, BRASSEUR S, GALLIARD H, PIAU JM. Systemic sclerosis: blood rheometry and laser Doppler imaging of digital cutaneous microcirculation during local cold exposure. Clin Hemorheol Microcirc [online] 1998 Apr, 18(1):47-58 [viewed 07 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/9653586
  5. ANDERSON ME, MOORE TL, HOLLIS S, JAYSON MI, KING TA, HERRICK AL. Digital vascular response to topical glyceryl trinitrate, as measured by laser Doppler imaging, in primary Raynaud's phenomenon and systemic sclerosis. Rheumatology (Oxford) [online] 2002 Mar, 41(3):324-8 [viewed 07 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/11934971
  6. STOYNEVA Z.. Laser Doppler-recorded venoarteriolar reflex in Raynaud's phenomenon. Autonomic Neuroscience [online] 2004 November, 116(1-2):62-68 [viewed 07 August 2014] Available from: doi:10.1016/j.autneu.2004.08.012
  7. KANETAKA T, KOMIYAMA T, ONOZUKA A, MIYATA T, SHIGEMATSU H. Laser Doppler Skin Perfusion Pressure in the Assessment of Raynaud's Phenomenon. European Journal of Vascular and Endovascular Surgery [online] 2004 April, 27(4):414-416 [viewed 07 August 2014] Available from: doi:10.1016/j.ejvs.2003.12.017
  8. LAU C.S., KHAN F., BROWN R., BELCH J.J.F.. Digital Blood Flow Response to Body Warming, Cooling, and Rewarming in Patients with Raynaud's Phenomenon. Angiology [online] 1995 January, 46(1):1-10 [viewed 07 August 2014] Available from: doi:10.1177/000331979504600101
  9. BOIGNARD A, SALVAT-MELIS M, CARPENTIER PH, MINSON CT, GRANGE L, DUC C, SARROT-REYNAULD F, CRACOWSKI JL. Local hyperemia to heating is impaired in secondary Raynaud's phenomenon. Arthritis Res Ther [online] 2005, 7(5):R1103-12 [viewed 07 August 2014] Available from: doi:10.1186/ar1785

Management - General Measures

Fact Explanation
Education of the patient and family Educating the patient and the family about the nature of the condition, provocative factors, management options and prognosis of the disease is mandatory and helps with compliance and long term outcome. [1] [2] [3]
Lifestyle modifications, Since there is not an underlying cause for primary Raynaud disease, lifestyle modification could be the only measure required for management. THe identified factors usually are cold/frozen drinks or food, cold air, cold water baths etc. Wearing protective socks or gloves when being exposed to such factors to prevent direct contact with them has also proved useful. Wearing body insulators is also recommended. Quitting smoking is also mandatory, since there has been strong evidence linked with smoking and Raynaud disease exacerbations. [4] [5] [6] [7] [8] [9] [10] The recognized drugs that are known to cause peripheral vasoconstriction should be avoided. i.e. nicotine, antihistamines [11]
References
  1. SUMMERS ANTHONY. From white to blue to red: Raynaud’s phenomenon. Emergency Nurse [online] 2005 November, 13(7):18-20 [viewed 07 August 2014] Available from: doi:10.7748/en2005.11.13.7.18.c1197
  2. O'CONNOR CARMEN MICHELLE. Raynaud's phenomenon. Journal of Vascular Nursing [online] 2001 September, 19(3):87-93 [viewed 07 August 2014] Available from: doi:10.1067/mvn.2001.117786
  3. KAUFMAN MELISSA W., ALL ANITA C.. Raynaud's disease: Patient education as a primary nursing intervention. Journal of Vascular Nursing [online] 1996 June, 14(2):34-39 [viewed 07 August 2014] Available from: doi:10.1016/S1062-0303(96)80013-6
  4. BAUMHäKEL M, BöHM M. Recent achievements in the management of Raynaud's phenomenon Vasc Health Risk Manag [online] 2010:207-214 [viewed 07 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2856576
  5. LEVIEN TL. Advances in the treatment of Raynaud's phenomenon Vasc Health Risk Manag [online] 2010:167-177 [viewed 07 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2860448
  6. HERRICK A. L.. Pathogenesis of Raynaud's phenomenon. Rheumatology [online] 2005 February, 44(5):587-596 [viewed 07 August 2014] Available from: doi:10.1093/rheumatology/keh552
  7. GARCíA-CARRASCO MARIO, JIMéNEZ-HERNáNDEZ MARIO, ESCáRCEGA RICARDO O., MENDOZA-PINTO CLAUDIA, PARDO-SANTOS RODRIGO, LEVY ROGER, MALDONADO CLAUDIO GALARZA, CHáVEZ GONZALO PéREZ, CERVERA RICARD. Treatment of Raynaud's phenomenon. Autoimmunity Reviews [online] 2008 October, 8(1):62-68 [viewed 07 August 2014] Available from: doi:10.1016/j.autrev.2008.07.002
  8. SUTER LISA G., MURABITO JOANNE M., FELSON DAVID T., FRAENKEL LIANA. Smoking, Alcohol Consumption, and Raynaud’s Phenomenon in Middle Age. The American Journal of Medicine [online] 2007 March, 120(3):264-271 [viewed 07 August 2014] Available from: doi:10.1016/j.amjmed.2006.06.007
  9. PALESCH YUKO Y, VALTER IVO, CARPENTIER PATRICK H, MARICQ HILDEGARD R. Association between Cigarette and Alcohol Consumption and Raynaud’s Phenomenon. Journal of Clinical Epidemiology [online] 1999 April, 52(4):321-328 [viewed 07 August 2014] Available from: doi:10.1016/S0895-4356(99)00005-0
  10. PLANCHON B., PISTORIUS M.-A., BEURRIER P., DE FAUCAL P.. Primary Raynaud's Phenomenon: Age of Onset and Pathogenesis in a Prospective Study of 424 Patients. Angiology [online] 1994 August, 45(8):677-686 [viewed 07 August 2014] Available from: doi:10.1177/000331979404500802
  11. ANDERSON J.E. et al. Raynaud’s Phenomenon of the Nipple: A Treatable Cause of Painful Breastfeeding. PEDIATRICS [online] Vol. 113 No. 4 April 1, 2004 pp. e360 -e364. [viewed 07 August 2014] Available from: http://pediatrics.aappublications.org/content/113/4/e360.long

Management - Specific Treatments

Fact Explanation
Topical nitroglycerin It acts as a regional vasodilator. It can also be used as a transdermal patch. [1] [2] [3] [4]
Calcium channel blockers It acts as a peripheral vasodilator. It also reduces the frequency of attacks. The preferred drug is nifedipine. [5] [6] [7]
References
  1. LEVIEN TL. Advances in the treatment of Raynaud's phenomenon Vasc Health Risk Manag [online] 2010:167-177 [viewed 07 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2860448
  2. HERRICK ARIANE L.. Therapy: A local approach to Raynaud phenomenon. Nat Rev Rheumatol [online] 2009 May, 5(5):246-247 [viewed 07 August 2014] Available from: doi:10.1038/nrrheum.2009.64
  3. FRANKS ANDREWG.. TOPICAL GLYCERYL TRINITRATE AS ADJUNCTIVE TREATMENT IN RAYNAUD'S DISEASE. The Lancet [online] 1982 January, 319(8263):76-77 [viewed 07 August 2014] Available from: doi:10.1016/S0140-6736(82)90215-X
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