TY - JOUR
T1 - Current management of Raynaud's syndrome.
AU - Landry, G. J.
AU - Edwards, J. M.
AU - Porter, J. M.
PY - 1996
Y1 - 1996
N2 - Raynaud's syndrome affects 20% to 25% of the population in cool, damp climates. Although its etiology and pathophysiology are poorly understood, treatment options do exist. For mild cases, the wearing of gloves, cold avoidance, tobacco cessation, and assurance that this is a nuisance condition that will not lead to finger amputation are often all that is required. Patients who fail this protocol are treated with extended-release nifedipine, 30 mg, at bedtime. In our experience, 70% to 80% respond with a decrease in severity and frequency of attacks, but 20% to 50% develop intolerable side effects. If nifedipine fails, we consider another calcium-channel blocker, an ACE inhibitor, or Dibenzyline. Biofeedback is offered to patients, but in our experience few are interested. Patients with digital ulceration are treated with nifedipine, pentoxifylline, and antibiotics as needed. We recommend soap-and-water washes and either a damp dressing or Silvadene cream. If there is chronic non-healing or intractable pain, we have on occasion performed a fingertip amputation. Although these do not tend to heal promptly, they generally do heal with time and provide excellent pain relief. We have not performed upper extremity sympathectomy for nonhealing finger ulcers in more than 20 years.
AB - Raynaud's syndrome affects 20% to 25% of the population in cool, damp climates. Although its etiology and pathophysiology are poorly understood, treatment options do exist. For mild cases, the wearing of gloves, cold avoidance, tobacco cessation, and assurance that this is a nuisance condition that will not lead to finger amputation are often all that is required. Patients who fail this protocol are treated with extended-release nifedipine, 30 mg, at bedtime. In our experience, 70% to 80% respond with a decrease in severity and frequency of attacks, but 20% to 50% develop intolerable side effects. If nifedipine fails, we consider another calcium-channel blocker, an ACE inhibitor, or Dibenzyline. Biofeedback is offered to patients, but in our experience few are interested. Patients with digital ulceration are treated with nifedipine, pentoxifylline, and antibiotics as needed. We recommend soap-and-water washes and either a damp dressing or Silvadene cream. If there is chronic non-healing or intractable pain, we have on occasion performed a fingertip amputation. Although these do not tend to heal promptly, they generally do heal with time and provide excellent pain relief. We have not performed upper extremity sympathectomy for nonhealing finger ulcers in more than 20 years.
UR - http://www.scopus.com/inward/record.url?scp=0030330703&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0030330703&partnerID=8YFLogxK
M3 - Review article
C2 - 8960343
AN - SCOPUS:0030330703
SN - 0065-3411
VL - 30
SP - 333
EP - 347
JO - Advances in surgery
JF - Advances in surgery
ER -