Abstract • Sublingual (SL) administration of nitroglycerin, a swinging arm maneuver, and biofeedback were evaluated for their effectiveness in decreasing hand rewarming time after ice immersion in six patients with Raynaud's disease and four patients with Raynaud's phenomenon. After ice immersion of their hands, ten normal patients showed rewarming to baseline temperatures in less than six minutes, while in nine of ten patients with Raynaud's syndrome, rewarming took more than 40 minutes. Two of ten patients with Raynaud's syndrome showed rewarming in less than six minutes after SL administration of nitroglycerin, while eight of ten patients with Raynaud's syndrome showed rewarming in less than 20 minutes after biofeedback training sessions. Six of the ten still showed rewarming in 20 minutes or less eight weeks after the sessions were over. A swinging arm maneuver provided no objective improvement. Sublingual administration of nitroglycerin provides a new alternative therapy for certain individuals. Effective biofeedback training can be learned in a relatively short time but should be reserved for the well-motivated patient. (Arch Dermatol 1983;119:396-399) References 1. Allen EV, Brown GE: Raynaud's disease: A clinical study of 147 cases . JAMA 1932;99:1472-1478.Crossref 2. Coffman JD, Davies T: Vasospastic disorders: A review . Progr Cardiovasc Dis 1975;18:123-146.Crossref 3. Rodnan GP: Progressive systemic sclerosis (scleroderma) , in McCarty DJ (ed): Arthritis and Allied Conditions , ed 9. Philadelphia, Lea & Febiger, 1979, pp 762-809. 4. Tuffaneli DL, Winkelmann RK: Systemic scleroderma: A clinical study of 727 cases . Arch Dermatol 1961;84:359-371.Crossref 5. Bennett R, Bluestone R, Holt PJL, et al: Survival in scleroderma . Ann Rheum Dis 1971;30:581-588.Crossref 6. Tuffanelli DL, Winkelmann RK: Diffuse systemic scleroderma: A comparison with acrosclerosis . Ann Intern Med 1972;57:198-203.Crossref 7. Haleprin JL, Coffman JD: Pathophysiology of Raynaud's disease . Arch Intern Med 1979;139:89-92.Crossref 8. Kontos HA, Wasserman AJ: Effect of reserpine in Raynaud's phenomenon . Circulation 1979;39:259-266.Crossref 9. McFadyen IJ, Housley E, MacPherson AIS: Intra-arterial reserpine administration in Raynaud's syndrome . Arch Intern Med 1973;132:526-527.Crossref 10. Leroy EC, Downey JA, Cannon PJ: Skin capillary blood flow in scleroderma . J Clin Invest 1971;50:930-939.Crossref 11. Allen BR: Griseofulvin in Raynaud's phenomenon . Lancet 1971;2:840-841.Crossref 12. Waldo R: Prazosin relieves Raynaud's vasospasm . JAMA 1979;241:1037-1043.Crossref 13. Franks AG Jr: Topical glyceryl trinitrate as adjunctive treatment in Raynaud's disease . Lancet 1982;1:76-77.Crossref 14. Gifford RW, Hines EA, Craig WM: Sympathectomy for Raynaud's phenomenon . Circulation 1958;17:5-13.Crossref 15. Mcintyre DR: A maneuver to reverse Raynaud's phenomenon of the fingers . JAMA 1978;240:2760.Crossref 16. Emery H, Schaller JG, Fowler RS Jr: Biofeedback in the management of primary and secondary Raynaud's phenomenon , abstracted. Arthritis Rheum 1976;19:795A. 17. Porter JM, Bardana EJ Jr, Baur GM, et al: The clinical significance of Raynaud's syndrome . Surgery 1976;80:756-763. 18. Lewis T: Experiments relating to the peripheral mechanism involved in spasmodic arrest of the circulation on the fingers: A variety of Raynaud's disease . Heart 1929:15:7-101. 19. Krabenbuhl B, Nielson SL, Lassen NA: Closure of digital arteries in high vascular tone states as demonstrated by measurement of systolic blood pressure in the fingers . Scand J Clin Lab Invest 1977;37:71-76.Crossref 20. Thompson ID: Vasospasm and cold . J Med Sci 1959;502:267-273. 21. Coffman JD, Cohen AS: Total and capillary fingertip flow in Raynaud's phenomenon . N Engl J Med 1971;285:259-263.Crossref 22. LeRoy EC, Downey JA, Cannon PJ: Skin capillary blood flow in scleroderma . J Clin Invest 1971;50:930-939.Crossref 23. Kleckner MS, Allen EV, Khalil GW: The effect of local application of glyceral trinitrate (nitroglycerine) on Raynaud's disease and Raynaud's phenomenon . Circulation 1959;3:681-689.Crossref 24. Stoebel CF, Glueck BC: Biofeedback treatment in medicine and psychiatry: An ultimate placebo? Semin Psychiatry 1973; 5:379-392. 25. Fuller GD: Current status of biofeedback in clinical practice . Am Psychol 1978;33:39-48.Crossref 26. Birk L (ed): Biofeedback: Behavioral Medicine . New York, Grune & Stratton Inc, 1973. 27. Shapiro D, Barker T, DiCara L, et al (eds): Biofeedback and Self-Control: An Aldine Annual on the Regulation of Bodily Processes and Consciousness . Chicago, Aldine Publishing Co, 1970.
Archives of Dermatology – American Medical Association
Published: May 1, 1983