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The role of the dermatologist in Raynaud's phenomenon: a clinical challenge
Author(s) -
MatucciCerinic C.,
Nagaraja V.,
Prignano F.,
Kahaleh B.,
BellandoRandone S.
Publication year - 2018
Publication title -
journal of the european academy of dermatology and venereology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.655
H-Index - 107
eISSN - 1468-3083
pISSN - 0926-9959
DOI - 10.1111/jdv.14914
Subject(s) - medicine , nifedipine , dermatology , intensive care medicine , differential diagnosis , secondary care , primary care , primary care physician , physical examination , refractory (planetary science) , surgery , pathology , calcium , physics , family medicine , astrobiology
Raynaud's phenomenon ( RP ) is a functional vascular disorder involving extremities. In his practice, the dermatologist may frequently encounter RP which affects mainly women and is categorized into a primary benign form and a secondary form associated with different diseases (infections, drugs, autoimmune and vascular conditions, haematologic, rheumatologic and endocrinologic disorders). Still today, the differential diagnosis is a clinical challenge. Therefore, a careful history and a physical examination, together with laboratory tests and nailfold capillaroscopy, is mandatory. RP is generally benign, but a scheduled follow‐up for primary RP patients should be established, due to risk of evolution to secondary RP . A combination of conservative measures and medications can help in the management of RP . The importance of avoiding all potential physical, chemical and emotional triggers, as well as quitting smoking, should be strongly suggested to the patient. As first‐line treatment, dihydropyridine calcium channel blockers should be used. If this approach is not sufficient, prostacyclin derivatives, phosphodiesterases inhibitors and endothelin receptor antagonists can be considered as second‐line treatment. In cases of acute ischaemia, nifedipine and intravenous prostanoids are helpful. In refractory cases, botulinum injections have shown a significant benefit. The approach to the RP patients requires therefore a coordinated care of specialists together with the primary care physician.