Raynaud's phenomenon

Raynaud's phenomenon (RP) is common, affecting between 3% and 5% of the population.

The diagnosis is made clinically: digits turn white (pallor) then blue with deoxygenation and/or red with reperfusion; pallor is well demarcated.

Primary RP often needs no pharmacological treatment. Keeping warm, smoking cessation, regular exercise, and avoiding stress are recommended. Pharmacological treatment can be considered in people with mild disease who do not respond to lifestyle measures. Potential treatment options include calcium-channel blockers, angiotensin-II receptor antagonists, selective serotonin-reuptake inhibitors (SSRIs), topical nitrates, alpha-blockers, and ACE inhibitors.

Secondary RP can be severe, especially when associated with systemic sclerosis (SSc). Other underlying conditions, exposures, or drugs can also cause secondary RP. In severe secondary RP, calcium-channel blockers, phosphodiesterase-5 inhibitors, prostacyclins, atorvastatin, and bosentan are potential treatment options, with only the most severe cases warranting surgical intervention.

Complications in secondary RP include severe digital ischaemia, gangrene, digital ulcers, and infection.

Pain relief and wound care of digital ulcers may be important adjunctive treatments.

Raynaud's phenomenon (RP) is characterised by vasospasm that causes digits to change colour to white (pallor) from lack of blood flow, usually brought on by cold temperatures. Affected areas subsequently turn blue due to de-oxygenation and/or red due to reperfusion. Both primary and secondary RP can be painful; however, secondary RP can lead to complications from prolonged periods of ischaemia.