blue and purple digits

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how to approach a patient with purple fingers or blue toes? very frequent problem ranging from simple raynaud's phenomenon to more severe ischemic gangrene due to cryoglobulins, vasculitis and systemic sclerosis

Santé & Médecine

Les Acrosyndromes Vasculaires
Expression clinique distale: main/pied
Paroxystique ou permanent
Signes fonctionnels variables:
• Douleurs, paresthésies, chaleur, froid…
• Modifications couleur peau Tb trophiques
Etiologies ??

Orteils BleusOrteils Bleus
Liés au froidLiés au froid Indépendant du froidIndépendant du froid
DommageDommage
geluresgelures
EngeluresEngelures
RaynaudRaynaud
Cryoglobulines
cryofibrinogene
Cryoglobulines
cryofibrinogene
Pouls
présent
Pouls
présent
Pouls
Absent
Pouls
Absent
Embols
Thrombi
Vasculite
Embols
Thrombi
Vasculite
Anxiété
Microembol
Choc
Infection
Hémorragie
Anxiété
Microembol
Choc
Infection
Hémorragie

Vasoconstriction au froid dans le phénomène de Raynaud

$Exposition au froid et humidité Contexte familial Oedème prurigineux Lésions violacées forment plaques Prurit ++ Diagnostic clinique Diagnostic différentiel avec lupus/SS/ sarcoïdose (b+ peau!) Guérison en 1 à 3 semaines Si réfractaire exclure un LMC$

Cryoglobulines et cryofibrinogene
Protéines qui précipitent à 4°c
Cryoglobuline de type I, II ou III
A ne pas confondre avec agglutinines
froides !!

Acrocyanose
• Etat cyanotique permanent
• Hiver/humidité
• Femmes jeunes, minces longiligne
• Contexte familial, perte de poids récent
• Liée à une hypertonie sympathique
• Réchauffement ne restaure pas la circulation sanguine
• Primaire ou secondaire
• Traitement symptomatique

Doigts sensibles au froid? Doigts changent de couleur?ils devient blancs ou bleus?

Traitement ischémie aigue
• Repos au chaud
• Contrôle de la douleur
- bloc digital
• Vasodilatateur
- inhibiteurs calciques
- Prostaglandines

AnticoagulationAnticoagulation
• Héparine
• HBPM
• Inhibiteurs thrombine (?)
Aucune étude randomisée
Disponible
Mais recommandation à
Court terme d’expert
Aucune étude randomisée
Disponible
Mais recommandation à
Court terme d’expert
Anti-fibrinolytique non
recommandée
Anti-fibrinolytique non
recommandée
AntiagrégantsAntiagrégants
Asaflow 80 mg

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blue and purple digits

1. Blue digits and blue toes M.S Soyfoo Department of Rheumatology Hôpital Erasme Logo Faculté ou entité

2. Logo ou entité Les doigts et orteils bleus: les causes?Les doigts et orteils bleus: les causes? Ischémie digitale: Conséquences? Morbidité? Ischémie digitale: Conséquences? Morbidité? Que faut il faire?Que faut il faire? Les Acrosyndromes vasculairesLes Acrosyndromes vasculaires

3. Les Acrosyndromes Vasculaires Expression clinique distale: main/pied Paroxystique ou permanent Signes fonctionnels variables: • Douleurs, paresthésies, chaleur, froid… • Modifications couleur peau Tb trophiques Etiologies ??

4. Orteils BleusOrteils Bleus Liés au froidLiés au froid Indépendant du froidIndépendant du froid DommageDommage geluresgelures EngeluresEngelures RaynaudRaynaud Cryoglobulines cryofibrinogene Cryoglobulines cryofibrinogene Pouls présent Pouls présent Pouls Absent Pouls Absent Embols Thrombi Vasculite Embols Thrombi Vasculite Anxiété Microembol Choc Infection Hémorragie Anxiété Microembol Choc Infection Hémorragie

10.

11.

12. Vasoconstriction au froid dans le phénomène de Raynaud

13. Gelures

14. Engelures

15.

16. Exposition au froid et humidité Contexte familial Oedème prurigineux Lésions violacées forment plaques Prurit ++ Diagnostic clinique Diagnostic différentiel avec lupus/SS/ sarcoïdose (b+ peau!) Guérison en 1 à 3 semaines Si réfractaire exclure un LMC

17.

18. Cryoglobulines et cryofibrinogene Protéines qui précipitent à 4°c Cryoglobuline de type I, II ou III A ne pas confondre avec agglutinines froides !!

19.

20. Acrocyanose • Etat cyanotique permanent • Hiver/humidité • Femmes jeunes, minces longiligne • Contexte familial, perte de poids récent • Liée à une hypertonie sympathique • Réchauffement ne restaure pas la circulation sanguine • Primaire ou secondaire • Traitement symptomatique

21. Doigts sensibles au froid? Doigts changent de couleur?ils devient blancs ou bleus?

22.

23.

24.

25.

26.

27.

28.

29.

30. Traitement des doigts bleus

31.

32.

33.

34.

35. Traitement ischémie aigue • Repos au chaud • Contrôle de la douleur - bloc digital • Vasodilatateur - inhibiteurs calciques - Prostaglandines

36.

37. AnticoagulationAnticoagulation • Héparine • HBPM • Inhibiteurs thrombine (?) Aucune étude randomisée Disponible Mais recommandation à Court terme d’expert Aucune étude randomisée Disponible Mais recommandation à Court terme d’expert Anti-fibrinolytique non recommandée Anti-fibrinolytique non recommandée AntiagrégantsAntiagrégants Asaflow 80 mg

Notes de l'éditeur

La peau : activité métabolique faible .. Elle s’adapte aux modifications de chaleur.. Pour evacuer la chaleur , le débit peut atteindre 7 à 8 l/min et en condition de froid, elle peut être nul…. la ciriculation de la peau est unique: microvasculature specialisée
Au niveau des zones de la peau glabre : il existe un nombre tres eleve de anastomoses art veineux qui sont impliqué dans la thermorégulation Quand il fait tres froid: le shunt est vaso constricté et pas de circulation
Hypereactivé symphatique Diminution de la dilation vasculaire parle flux .. Augmnentation de endothéline

blue and purple digits

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blue and purple digits

Notes de l'éditeur