PREFERRED PRACTICE PATTERN
7A: Primary Prevention/Risk Reduction for Integumentary Disorders
7E: Impaired Integumentary Integrity Associated with Skin Involvement Extending into Fascia, Muscle, or Bone, and Scar Formation1
A 56-year-old female presents with bilateral hand and finger pain. She states that her hands and fingers are always cold. She especially has difficulty in the supermarket when reaching for frozen foods. She notices her fingers go blue and then white. She states the pain occurs when they start to warm up. She carries gloves with her even during the summer months.
Vasospasm of the arteries to the distal extremities
Most common in the fingers and toes, can affect the nose, ears, and lips
Sensitivity to cold
Primary Raynaud’s, the etiology is unknown, more common
Secondary Raynaud’s has a known etiology from another disease or cause
Ischemic phase of attack of Raynaud phenomenon with marked pallor of the ring and little fingers of the left hand and little finger of the right hand. (From Goldsmith LA, Katz SI, Gilchrest BA, et al. Fitzpatrick’s Dermatology in General Medicine. 8th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Cold temperature can cause a Raynaud attack where there is a brief period of little-to-no blood flow.
Brief temperature changes can cause an attack
Can cause skin sores or gangrene
Affects 10% of the population
Primary Raynaud’s usually begins before age 30
Secondary Raynaud’s usually begins after age 30
Women are more likely than men, 4:1 ratio
Living in cold regions
Loss of pulp of the pad of the digit with pitting scars and ulcerations from chronic, severe Raynaud phenomenon. (From Goldsmith LA, Katz SI, Gilchrest BA, et al. Fitzpatrick’s Dermatology in General Medicine. 8th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Nailfold capillary microscopy, in a patient with scleroderma, showing capillary drop out with enlarged, dilated, tortuous capillary loops. (From Goldsmith LA, Katz SI, Gilchrest BA, et al. Fitzpatrick’s Dermatology in General Medicine. 8th ed. www.accessmedicine.com...
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