Raynaud's Phenomenon
A syndrome of peripheral vasospasm with intermittent cutaneous pallor or cyanosis.
Symptoms, Signs, and Diagnosis
Exposure to cold typically causes blanching, then cyanosis of the hands and feet and sometimes of the ears and nose. An erythematous phase follows when patients enter a warm environment. Episodes can be painless or produce varying degrees of pain, numbness, and cold sensation. Many elderly patients experience only the blanching or cyanotic phase, which may occur even when the ambient temperature is not very cool. Affected persons tend to have cool hands and feet even in a warm environment. If the episodes are severe or of long duration, sclerodactyly may develop.
Bilateral symptoms (affecting both hands) beginning after age 40 usually indicate internal disease, such as hypothyroidism, drug-induced systemic lupus erythematosus, cryoglobulinemia, cryofibrinogenemia, cold agglutinin disease, scleroderma, and the CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, telangiectasia). Patients with cold agglutinin disease often have a low-grade lymphoma. Unilateral symptoms usually indicate that previous frostbite or a thoracic outlet syndrome is the cause.
Treatment
Generally, treatment of elderly patients with Raynaud's phenomenon should be conservative: Patients should be instructed to wear warm clothing and avoid cold. Smokers should stop smoking.
If Raynaud's phenomenon is caused by scleroderma, treatment should usually be more vigorous, because episodes are associated with reversible but damaging decreases in renal and cardiac blood flow and with impaired myocardial contractility. Nifedipine 10 mg po tid is usually safe and effective. Griseofulvin 250 mg po bid may also help. Ketanserin, a selective 5-hydroxytryptamine2 receptor antagonist, may be beneficial but is not yet available in the USA. |
