Raynaud Phenomenon
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
Characteristic features
- Paroxysmal bilateral digital pallor and cyanosis followed by rubor.
- Precipitated by cold or emotional stress; relieved by warmth.
- Primary form benign course, usually affects young women.
- Secondary form: can cause digital ulceration or gangrene.
Treatment: A) General Measures
- Patients should wear gloves or mittens whenever in temperatures that precipitate attacks.
- Wearing warm shirts, coats, and hats will help prevent the exaggerated vasospasm that causes RP and that is not prevented by warming only the hands.
- The hands should be protected from injury at all times wounds heal slowly, and infections are consequently hard to control.
- Softening and lubricating lotion to control fissured dry skin should be applied to the hands frequently.
- Smoking should be stopped and sympathomimetic drugs (e.g. , decongestants , diet pills , and amphetamines ) should be avoided.
- For most patients with primary RP, general measures alone are sufficient to control symptoms.
- Medical or surgical therapy should be considered in patients who have severe symptoms or are experiencing tissue injury from digital ischemia.
B) Medications
- Tab - Nifedipine (Adalat LA) 30-180 mg, PO x OD ' OR '
- Tab- Amlodipine (Sofvasc / Norvasc / Zodip) 5-20mg, PO x OD'
- Other medications that are sometimes effective in treating RP include angiotensin Il receptor blockers, topical nitrates, phosphodiesterase inhibitors (e.g. sildenafil, tadalafil, and reuptake inhibitors serotonin selective vardenafil), ( fluoxetine ) , statins , or endothelin - receptor inhibitors ( i.e. . bosentan ).
- Severe or refractory episodes can be treated with intravenous infusions of prostacyclin or prostacyclin analogs ( e.g. , epoprostenol , iloprost , treprostinil )
Surgical Measures
Sympathectomy may be indicated when attacks have become frequent and severe, when they interfere with work and well - being, and particularly when trophic changes have developed and medical measures have failed.Digital sympathectomy may improve secondary RP.
When to Refer
Appropriate management of patients with secondary RP often requires consultation with a rheumatologist
When to Admit
Patients with severe digital ischemia as evidenced demarcation should be admitted for intensive therapy.