raynaud’s phenomenon

Raynaud’s Phenomenon

Dr. Fardan QadeerDept. Of Pathology

CIMS and H

It is a vasospastic disorder causing discoloration of the fingers, toes, and occasionally other areas.

• Raynaud's phenomenon – Raynaud's disease (also known as "Primary

Raynaud's phenomenon") where the phenomenon is idiopathic

– Raynaud's syndrome(secondary Raynaud's), where it is caused by some other instigating factor, most commonly connective tissue disorders

PathogenesisExaggerated Vasomotor Response

STRESSCOLD

Sympathetic Stimulation

Vasoconstriction

HYPOXIA

Pathogenesis

Primary Raynaud’s

Raynaud's disease• Idopathic• It often develops in young women in their teens

and early adulthood. • Smoking worsens frequency and intensity of

attacks, and there is a hormonal component.• Caffeine also worsens the attacks. • Associations: migraine and angina

Secondary Raynaud's

Raynaud's syndrome • It occurs secondary to a wide variety of other

conditions. Secondary Raynaud's has a number of associations:

• Connective tissue disorders:– scleroderma– systemic lupus erythematosus– rheumatoid arthritis– Sjögren's syndrome– dermatomyositis– polymyositis

CynosisIschemia

PallorVasospasm Rubor

Clinical Features:

Chronic, recurrent cases of Raynaud phenomenon can result in atrophy of the skin, subcutaneous tissues, and muscle. In rare cases it can cause ulceration and ischemic gangrene.

Treatment• Secondary Raynaud’s: Treatment of underlying

Cause• Primary Raynaud's: Avoiding triggers.– Extreme Cold Exposure– Caffeine– Coffee– Avoidance of Emotional Stress

• Emergency Care:– allow tepid to slightly warm water to run over the

affected digits while you gently massage the area. Continue this process until the white area returns to its normal, healthy color.

– place the affected digits in a body cavity—armpit, crotch, or even the mouth. Keep the affected area warm at least until the whiteness returns to its normal, healthy color

– Vigorous hand movement will allow the blood circulation to increase

• Drug Therapy:– Calcium Channel Blockers– In a study published in the November 8, 2005

issue of Circulation, sildenafil (Viagra) improved both microcirculation and symptoms in patients with secondary Raynaud's phenomenon resistant to vasodilator therapy

– Fluoxetine, can be useful for management of emotional stress

• Surgery:– Sympathectomy