Colour changes during 'Raynaud's phenomenon' and finger blood supply during direct and indirect cooling procedures.

Abstract

Summary The influence of body (indirect cooling) and local linger cooling on finger blood pressure and blood flow was examined in 48 patients claiming Raynaud's phenomenon. Twenty-four were suffering from generalized scleroderma (GS) and 24 from Raynaud's disease (RD). Skin blood flow was measured by laser Doppler flowmetry and blood pressure measurement at different temperatures was performed by a ‘digit-cooling’ system, Colour changes during Raynaud arracks, as described b the patients, were noted. The patients could be divided into three groups: (1) Mild cases where combined finger and body cooling was needed to elicit flow arrest (Raynaud attack), or flow arrest could not be elicited in the laboratory (79% of RD and 33% of GS). Flow stop in these cases seemed to occur distally to the digital arteries. This finding was highly correlated to attacks described as pallor followed by varying degrees of rubor. (2) More severe cases, where flow arrest could be elicited after local finger cooling alone (50% of the GS and 19% of the RD patients). Here, flow stop seemed to occur at the level of the digital arteries. This finding was highly correlated to attacks described as pallor followed by cyanosis, and rubor in varying degrees. (3) The most severe cases where finger circulation stopped after body cooling (indirect cooling) alone. This was seen in 25% of GS patients. The finding was correlated with attacks described as finger cyanosis as an isolated finding, which was only seen in GS. Therefore, observing any form of finger cyanosis during Raynaud's attacks in patients should lead one to suspect an underlying disease, which may often be a connective tissue disease.