A 52 years female presenting with a history of increasing discoloration of the tips of her thumb and index finger, and this appeared to be a Raynaud's phenomenon (Figure 1), for which I started her on vasodilator Nifedipine 10 mg daily, and she returned 1 week later with improvements in the thumb discoloration but not her index finger. So I asked her to get a Preparation of Nifedipine cream for local application, and she returned 2 days later with the index pain blue, painful and mild sloughing of the skin as it had blistered and she burst it. I immediately sent her to the Emergency department for a vascular review fearing thrombotic event. She was seen and immediately started on Clexane Subcut, and also initiated with Warfarin (Marevan). This is a case of ULNAR artery occlusion. She is now asymptomatic and has no more blue discoloration, pain is now significantly reduced. As no haematological or autoimmune case can be determined this is a case of smoking related thrombosis with possible HRT effect.

Figure 1: Discoloration on the tips of Fingers.