EpistemisRaynaud's phenomenon
Specialty: Skin.
Why it occurs
- Primary or idiopathic Raynaud's disease (exaggerated physiological vasospasm without vascular structural damage, common in young women)
- Progressive systemic sclerosis/scleroderma (main secondary cause, characterized by endothelial fibrosis and intimal hyperplasia)
- Systemic lupus erythematosus (immune complex-mediated inflammation of the vessel wall)
- Sjögren's syndrome (associated vasculopathy)
- Repetitive trauma or occupational use of vibrating tools
- Vasoconstrictor drugs such as non-selective beta blockers or ergot derivatives.
Initial workup
Capillaroscopy of the nail bed (detection of megacapillaries and areas of avascularity), screening for antinuclear antibodies (ANA) by indirect immunofluorescence, anticentromere and anti-Scl-70 antibodies, erythrocyte sedimentation rate (ESR), and arterial Doppler ultrasound of the upper limbs if there is pulse asymmetry.
red flags
Presence of punctate digital necrosis, active and painful ischemic ulcers on the fingertips, severe asymmetry in color or radial/ulnar pulses, or persistence of the cyanotic phase for more than two hours without response to passive rewarming.
Standard management
- Extended-release nifedipine — calcium antagonist that reduces arteriolar smooth muscle tone; starting dose of 30 mg/day, monitoring headache and edema
- Sildenafil — phosphodiesterase-5 inhibitor that increases local nitric oxide, used in refractory secondary cases or with ulceration
- Nitroglycerin 2% ointment — local vasodilator for topical application in affected areas
- Losartan (angiotensin II receptor antagonist with additional peripheral vasodilatory effects).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Skin
- Listed causes
- 6
- Treatment options
- 4