PRIMARY DIAGNOSIS OF RAYNAUD'S PHENOMENON IN ADOLESCENT CHILDREN

Raynaud's phenomenon is a well- defined clinical syndrome with a prevalence of 3-5% of the total population, with a higher frequency in cold climatic zones. It is characterized by recurrent episodes of cold-induced finger vasospasm, chemical or emotional triggers. FR is classified as primary if it manifests itself in isolation, or secondary if it is associated with an underlying disease, mainly connective tissue disease. In both cases, it manifests itself as a kind of "triple" (pallor, cyanosis and erythema) or "double" color changes. Primary RF is usually a benign condition, while secondary can develop and be complicated by finger ulcers and gangrene, which may require surgical treatment. Although the pathogenesis of FR remains not fully understood, Raynaud's phenomenon occurs in childhood, especially in adolescents, where its presence may indicate the risk of developing autoimmune connective tissue diseases. Diagnosis of FR includes careful history collection, physical examination, as well as nail capillaroscopy, which allows to evaluate microcirculatory changes and helps to distinguish FR from other vasomotor disorders (for example, acrocyanosis, perniopathy, neuropathy of small fibers with vasomotor symptoms and complex regional pain syndrome). In children, the need for diagnosis is determined by a thorough assessment, in particular in the case of severe or prolonged symptoms, since the primary diagnosis of Raynaud's in childhood can help identify potential risks of developing connective tissue diseases. Regardless of etiology, treatment includes warming with avoidance of triggers and consideration of vasodilator prescribing (e.g., calcium channels, alpha-1 blockers). Secondary FR with finger ulcers may require PDE5i, endothelin-1 receptor blockers, and prostanoids. In refractory cases, interventions such as pneumatic arterial pumps, botulinum toxin administration, or surgical sympathectomy may be performed.