Raynaud phenomenon results from transient, acral vasocontraction and manifests as well-demarcated pallor, cyanosis, and then erythema as the affected body part reperfuses.5 Similar to pernio, it can be categorized as either primary or secondary.5 Primary phenomenon is idiopathic. Secondary phenomenon is thought to be a result of autoimmune disease, use of certain medications, occupational vibratory exposure, obstructive vascular disease, or infection.5
In the absence of a history of exposure to subfreezing temperatures, frostbite can be excluded from the differential diagnosis.
Treatment entails rewarming
The aim of frostbite treatment is to save injured cells and minimize tissue loss.1 This is accomplished through rapid rewarming and—in severe cases—reperfusion techniques.
Tissue should be rewarmed in a 37°C to 39°C water bath with povidone iodine or chlorhexidine added for antiseptic effect.1 All efforts should be made to avoid refreezing or trauma, as this could worsen the initial injury.2 Oral or intravenous hydration may be offered to optimize fluid status.1 Supplemental oxygen may be administered to maintain saturations above 90%.1 Nonsteroidal anti-inflammatory drugs are helpful for analgesia and anti-inflammatory effect, and opioids can be used for breakthrough pain.1 It is recommended that blisters be drained in a sterile fashion and that all affected tissue be covered with topical aloe vera and a loose dressing.1,2,4
Treatment of severe frostbite. Angiography should be performed on all patients with third- or fourth-degree frostbite.3 If imaging shows evidence of vascular occlusion, tissue plasminogen activator (tPA) and heparin can be initiated within 24 hours to reduce the risk for amputation.8-10
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