Common clinical features involve angiospasm of the arterioles of the digital arterial trees due to the effects of an exciting stimulus which are frequently cold temperature and/or emotional stress. Arterial doppler studies and/or arteriograms will assist in ruling out occlusive disease and this disease may be confirmed by exposure of the reactive part to cold temperature to demonstrate the integumental color changes. Initially there is pallor due to vasospasm with the absence of the hunting reflex (as described by Sir Thomas Lewis) which would commonly follow a short period of pallor. Subsequently, the capillaries and venules become fully dilated with venule to capillary reflux and resulting cyanosis due to blood stagnation. In advanced histories their may be ulcerations and necrosis at the fingertips due to intimal thickening and thrombo-occlusive disorder.
Treatment, especially in the initial history, involves patient instruction in prophylaxis by avoiding the source stimulus. Mecholyl pulsed phonophoresis may be effective, but care must be exercised in its administration to avoid flushing, perspiring, salivation, tachycardia, hyperperistalsis, and hypotension which are systemic effects that are undesirable. Mecholyl vasodilation may last for six to eight hours using a 0.2 percent solution. Smoking is prohibited. Occasionally, the simple act of warming the hands and the body is an effective way of aborting an episode. The treating physician is reminded that thermal agents must be applied to the body in such a manner that heat is dissipated by the tissues at a rate equal to or faster than the rate at which is generated in order to avoid thermal tissue injury.
Vascular tumors, such as subungal glomus tumor and other organic etiologies, must be ruled out as a nidus of angiospasm to render a diagnosis of Raynaud's disease. Raynaud's phenomenon should properly be referred to the appropriate specialty for correct evaluation and treatment if suspected or known to be present clinically.
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R. Vincent Davis, DC, BSPT, DNBPME