Onset may be gradual or sudden with coldness, numbness, tingling or burning and often excruciating pain.
Extremities show trophic changes, especially of the nails and Skin.
Diminution or absence of arterial pulsation is noted. It is absolutely imperative that the patient stop smoking completely and forever for there will be no healing unless this is accomplished - no matter what therapy is used. Greater or lesser degrees of malnutrition are almost always noted. Adequate diet is essential. Supplies oxygen to peripheral arteries and brings great relief from pain.