(Local asphyxia; Raynaud’s disease)
Definition. A rare affection occurring at the periphery of the circulation and characterized by local ischemia and asphyxia, and usually ending in gangrene of the skin and deeper tissues which is often symmetrically distributed.
Symptoms. Extremities such as the fingers and toes, or less often the nose, ears and brows or rarely other locations may be attacked. The first indications are coldness and paleness of the parts affected (local ischemia). Numbness, loss of sensation, pain and pallor may precede or follow the initial symptoms. After a variable period the second stage (local asphyxia) develops with sensations of prickling, crawling, stinging and pain with a swollen dark red, livid or bluish appearance. Unless the disease be arrested at this or an earlier period, the third stage, that of superficial dry gangrene, is developed. At this time, the skin may be cold, firm and dark in color, with vesicles and bullae along the edge of the gangrenous patch. The line of demarcation is pronounced and the necrosed parts eventually slough off. In milder cases, the ulceration is superficial and recovery ensues, leaving the fingers thinned and covered with small, white, tough scars or the tissues may regain their tone without ulceration or the nails alone may fall, as I have noticed in two cases.
Etiology and Pathology. This condition usually follows directly from exposure to cold but has been observed after the exanthemata, diphtheria, malaria, gout, diabetes, syphilis, tuberculosis and various neuroses. Leloir claims that it is most common between the ages of fifteen and thirty-five and that four-fifths are females. Most of my cases have been young males. Pathologically it is a trophoneurosis of the skin, of a circulatory nature due to peripheral or central causes.
Diagnosis. This should be readily made where there is a history of local asphyxia, the location of the gangrenous process is symmetrical and on the extreme parts of the body.
Prognosis and Treatment. The former is good when the affected areas are small but there is a tendency to recurrence. It is bad when the process is extensive or the general conditions unfavourable. Disfigurement or mutilation is the rule. Treatment aims to improve physiological living by general and local measures, such as proper diet, exercise, galvanization of the spine and affected parts (the positive electrode being applied to the spine and the negative immersed with the affected part in water) or the local application of the high-frequency currents. Stimulation and friction with alcoholic, camphorated or oily lotions for the mild cases and antiseptic and surgical treatment for the later stages may be indicated. Calcarea fluor, Fluoric acid, Secale and Vipera have benefited my cases.