RAYNAUDS-PHENOMENON ASSOCIATED WITH TIP NECROSIS

Among patients with Raynaud's phenomenon, the occurrence of digital necrosis constitutes a specific circumstance for at least five reasons : 1. Raynaud's disease seems unlikely, 2. a basic mechanism involving an organic vascular impairment, as opposed to a vasospastic mechanism, is highly probable, 3. extensive evaluation is necessary until the underlying disease is discovered, 4. these patients are at risk of amputation, and 5. conservative treatment is not sufficient and other treatments including hemodilution, epidural stimulation and prostacyclin must be envisaged. Careful specialized digital nursing is also necessary. When possible, a causative treatment might be considered. For all the above reasons patients with Raynaud's phenomenon combined with tip necrosis should be referred to physicians specialized in Vascular Medicine.