Toes and fingers turning white: Raynaud's phenomenon

I am 22 years old and for several months I have been suffering from the so-called Raynaud's phenomenon, with a capillaroscopy showing megacapillaries and a scleroderma pattern / dermatopolymyositis pattern, although with negative ANA and anti ENA. I am now taking a vasodilator, what should I expect?

He replies Carlo Selmihead of Rheumatology and clinical immunology, Humanitas Institute, Milan (GO TO THE FORUM)

Raynaud's phenomenon represents a disorder of the peripheral circulation for which, at the level of the extremities (hands, feet, but also nose and ears), some stimuli, especially cold and intense emotions, first cause a pale phase with white skin color, then a cyanotic phase with bluish skin, and finally a reperfusion with a bright red color. The entire disorder lasts on average 20-30 minutes and can be very annoying and even painful. In most cases, primary Raynaud's phenomenon, i.e. a symptom that does not imply a systemic disease and often affects young women with mothers or sisters affected by the same phenomenon. However, when the disorder is associated with a disease, especially systemic sclerosis or another connective tissue disease
we are talking about a secondary form.

Exams

To distinguish between the two, they are useful capillaroscopy (a non-invasive test that investigates the shape of the capillaries of the cuticles of the fingers) and laboratory tests (especially anti-nuclear autoantibodies – ANA – or their subtypes, especially anti-ENA). Capillaroscopy mainly investigates the presence of very large capillaries, called megacapillariesor the presence of areas without capillaries, defined as avascular, often associated with very early forms of systemic sclerosis (early scleroderma pattern). The negativity of both investigations suggests a primitive form, but in some cases there is a discrepancy between capillaroscopy and laboratory tests: in these cases it may be useful to repeat the antibody tests, including rare antibodies for myositis and scleroderma, in a reference center .

Therapy

If the tests are confirmed negative, it is suggested to observe the trend over time by using a vasodilatory therapy with calcium channel blockers which allows the severity of the symptom to be reduced, although it may be poorly tolerated due to the effect of reduction in blood pressure. When this therapy is not sufficient and, for example, small ulcers form on the fingers which take a long time to heal, they can be used intravenous vasodilators such as prostanoids, which are administered in a hospital setting.

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