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Raynaud’s Syndrome

Paroxysmal vasoconstriction of the digital arteries causing ischaemia, cyanosis and eventually reactive hyperaemia.

• Primary disease ] Appears in 3rd decade of life (males<females)
   

      o Unknown cause

• Secondary phenomenon

     o Cold exposure

     o Trauma

     o Collagen disease

     o Occlusive arterial disease

     o Neurological lesions

     o Intoxications

     o Other (tumour, cold injury etc)

-Clinical stages:

• Pallor

• Cyanosis

• Rubor

• Return to normal

-Treatment

• Prophylactic

• Cease smoking

• Vasodilation drugs

• Sympathectomy

• Psychotherapy

Erythema pernio (chilblains)

A hypersensitivity reaction to cold

-Predisposing factors

• Occur mostly on the extremities

• Inadequate hosiery for the climate

• Poor hypothalamic control

• Low socio-economic status (nutrition & housing)

• Compromised circulation

• Neurological disturbances

• Endocrine imbalance

-Pathology

• Exposure to cold --> Arterioles, pre-capillary sphincters and superficial capillaries contract (Pallor)

• Decrease skin temperature --> lower metabolic rate of tissue

• Enter warm environment --> increase metabolic rate without vasodilation (Cyanosis) ‘Cyanotic stage’

• Accumulation of metabolites --> tissue damage

• Eventual reactive hyperaemia --> Red, hot and swollen digit (Erythema) ‘Hyperaemic stage’

• Pain/itching -->‘Congestive stage’

• Chronic inflammation --> fat necrosis & local ulceration --> broken chilblain

Treatment

-Depends on stage

• Prophylactic -Warm hosiery
-Paraffin wax baths
-Avoid cold

• Tincture of benzoin

• Iodine solution

• Methyl Salicylate

• Other rubefacients

• Calamine lotion

• Burrows solution

• Witch Hazel solution

• Other Astringents

• Hibitane cream

• Ichthammol collodion

• Betadine ointment/solution

Erythromelalgia

Excessive vasodilation of the arteries and arterioles causing erythema and burning pain.

• Primary

• Secondary

-Clinical features:

• Increase skin temperature

• Erythema

• Bounding pulses

• Burning pain

• Hyperhidrosis

• Bilateral or unilateral

-Treatment

• Elevate limb

• Cool environment

• Vasoconstriction drugs

• Analgesics

• Treat hyperhidrosis

Frostbite

Acute local injury of the tissues produced by exposure to temperatures of -4º or lower.

• Vasoconstriction of the arterioles and distal arteries

• Freezing of intercellular fluids

• Upon thawing intense vasodilation and erythema

• Vessel wall damage and occlusion from thrombi

-Clinical characteristics

• 1st degree

• 2nd degree

• 3rd degree

• 4th degree

-Treatment

• Restore temperature

• Treat oedema, blisters

• Possible amputation or skin grafts

• Anticoagulant therapy

-Podiatric treatment

• Treat keratoses and scar tissure

• Treat oedema, blisters

• Advice on footwear

Trench/Immersion foot

Trench foot- First World War

Immersion foot- Second World War

(Identical conditions)

-Prolonged exposure of tissues to cold and wet environment (above freezing point)

• Constricted stage

• Hyperaemic stage

• Gangrene

• Sensory and motor neuropathy

• Secondary Raynaud’s phenomenon

• Drop foot

-Treatment

As for frostbite

ePodiatry's patient information on chilblains and links on vasospatic conditions.

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