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Raynaud’s phenomenon is a condition notable for vasospasm of the digits that is associated with local pallor, cyanosis, and pain. Raynaud’s phenomenon may be precipitated by cold or emotional stress and is either primary or secondary to connective tissue disease. Secondary Raynaud’s phenomenon may have significant associated morbidity, including digital ulceration and infection, making thoughtful management imperative. The foundation of therapy is comprised of measures such as smoking cessation, avoidance of vasoconstricting drugs, and maintenance of body and extremities warmth/avoidance of cold temperatures with protective wear like insulated gloves. A broad range of medical intervention is also available for patients with severe or recalcitrant symptoms despite careful observation of supportive measures. For such cases, the authors advise a trial of calcium channel blockers, followed by consideration of substitution with fluoxetine, sildenafil, or botulinum toxin. See Table 132-1.
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Levels of evidence are based on the Journal of the American Academy of Dermatology guidelines: level IA evidence includes evidence from meta-analysis of randomized controlled trials; level IB evidence includes evidence from ...