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CONDITION/DISORDER SYNONYMS

  • Raynaud phenomenon

  • Raynaud’s

  • Primary Raynaud’s

ICD-9-CM CODE

  • 443.0 Raynaud syndrome

ICD-10-CM CODES

  • I73.00 Raynaud syndrome without gangrene

  • I73.01 Raynaud syndrome with gangrene

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

PATIENT PRESENTATION

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.

KEY FEATURES

Description

  • 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

Essentials of Diagnosis

  • Primary Raynaud’s, the etiology is unknown, more common

    • Criteria for primary Raynaud phenomenon (see table)2

  • Secondary Raynaud’s has a known etiology from another disease or cause

    • Criteria for secondary Raynaud phenomenon (See table)

      • Connective tissue disease

      • Obstructive arterial disease

      • Neurologic disorders

      • Drugs and toxins

      • Occupational/environmental exposure

      • Hyperviscosity

FIGURE 16-1

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.)

General Considerations

  • 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

Demographics

  • 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

  • Family history

  • Living in cold regions

FIGURE 16-2

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.)

FIGURE 16-3

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. Copyright ...

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