Raynaud’s Phenomenon

Vasoreactive color changes in fingers and toes on exposure to cold or stress occurs in 10 percent of adults, and the onset is frequently seen in childhood with some cases starting in the first few years of life.

Although the classic triphasic presentation of pallor, followed by cyanosis and ultimately hyperemia is usually seen, incomplete forms are frequently seen. Reversal with rewarming is historically helpful.

In adults over age 35 years, new onset Raynaud’s may be a harbinger of a rheumatic disease, but such progression is rare in childhood if the patients do not manifest symptoms at the onset of their vasoreactive episodes. The only additional physical finding in a patient with Raynaud’s is delayed capillary refill of otherwise normal appearing capillary vessels.

Treatment

Treatment involves education about keeping fingers and toes warm. If a patient is on a medication for ADHD, they may have more Raynaud’s episodes, but the medication does not need to be stopped as little medical consequence will occur. In very symptomatic Raynaud’s patients, treatment with calcium channel blockers such as nifedipine will usually provide relief.