It should be emphasized to the patients that overall body warmth is important. It must be strongly emphasized to stop all tobacco use, as nicotine enhances digital vasospasm. Conservative therapy, to include tobacco avoidance, use of P2 profile, and a trial of nifedipine, should be tried before making a referral. An occasional patient will have evidence of Raynaud's disease, which is associated with more prolonged vasospasm after cold exposure and is classically associated with triphasic color changes. Nearly all patients exhibiting this phenomenon will be sensitive to the cold.
Initial management is the same as noted above for patients with simple cold sensitivity.
Patients who exhibit the color changes typical of Raynaud's may benefit from nifedipine 10 mg tid. Ongoing Management and Objectives To maintain comfort during periods of low ambient temperature. Indications for Specialty Care Referral Please note that conservative therapy, to include tobacco avoidance, use of P2 profile, and a trial of nifedipine, should be tried before making a referral. Patients with a history of second-degree or greater frostbite who have cold sensitivity that does not respond to conservative measures should be referred to the Vascular Clinic. Patients who manifest the signs of Raynaud's disease and have cold sensitivity not responsive to conservative measures should be referred to the Vascular Clinic.