What is the treatment for Raynaud's phenomenon?
Management of Raynaud's phenomenon involves preventing the spasm of the blood vessels by protecting the fingers and the toes from cold, trauma, and infection. Medications that can aggravate blood vessel spasms should be avoided by patients with RP. In patients with persistent symptoms, medications that dilate the blood vessels (angiotensin-receptor blockers and calcium channel blockers [amlodipine, nifedipine, felodipine]) can be administered.
Patients with Raynaud's phenomenon who have no symptoms other than the color changes of extremities may require only home-remedy measures to prevent complications. Prevention measures are important in primary and secondary RP regardless of the severity. Simple initial care involves keeping the body warm, especially the extremities. Warm clothing in colder environments is essential. Cotton gloves can be helpful while searching the freezer. Headwear can help the body retain heat by minimizing heat dissipation. Room temperatures should not be too cool. Rubber gloves protect the hands and prevent cooling while washing dishes. Barefoot walking should be minimized. Compression of the blood vessels by tight-fitting wrist bands, rings, or footwear should be avoided.
Note: Some energy companies offer some discounts on utility bills for those who suffer from Raynaud's phenomenon because of the additional heating requirements.
Those with RP should guard their hands and feet from direct trauma and wounds. Any wounds or infections should be treated early to prevent more serious infections. Avoiding emotional stresses and tools that vibrate the hand may reduce the frequency of attacks. Biofeedback can also help to decrease the severity and frequency of RP in some patients.
Direct and indirect (passive or secondhand smoke) smoking should be avoided by patients with RP. The chemicals in tobacco smoke can cause blood-vessel constriction and lead to atherosclerosis (hardening of the arteries), which can further impair the oxygen supply to the extremities.
Care of the nails must be done carefully to avoid injuring sensitive toes and fingertips. Ulcers on the tips of the digits should be monitored closely by the doctor. These can become infected. Gently applied finger splints are used to protect ulcerated areas. Ointments that open the blood vessels (nitroglycerin ointment) are sometimes used on the sides of severely affected digits to allow increased blood supply and healing.
Patients with persistent or bothersome symptoms may be helped by taking oral medications that open (dilate) blood vessels. (Sometimes these medications are decreased or eliminated when the environment is warmer, such as during the summer months.) These include calcium antagonists (or calcium channel blockers), such as diltiazem (Cardizem, Dilacor), nicardipine (Cardene), nifedipine (Procardia), and other medicines used in blood pressure treatment, such as methyldopa (Aldomet) and prazosin (Minipress). Recent research has shown that the blood-pressure drug losartan (Cozaar, Hyzaar) can reduce the severity of episodes of RP.
Medications that thin the blood, such as low doses of aspirin or dipyridamole (Persantine), are sometimes helpful.
Some patients with persistent symptoms can benefit by adding a medication called pentoxifylline (Trental), which makes the red blood cells more pliable and thereby improves circulation.
Severe RP can lead to gangrene and the loss of digits from a lack of blood supply. With severe disease, nerve surgery called "sympathectomy" is sometimes considered. In this procedure, to prevent blood-vessel spasm, the nerves that stimulate the constriction of the vessels (sympathetic nerves) are surgically interrupted. Usually, this is performed during an operation that is localized to the sides of the base of the fingers at the hand. Through small incisions, the tiny nerves around the blood vessels are stripped away. This procedure is referred to as digital sympathectomy.