Treatment for Raynaud's Phenomenon
The following are some lifestyle tips for managing Raynaud's phenomenon:
- Keeping warm is the primary goal for preventing the onset of Raynaud's phenomenon. Air-conditioning and exposure to refrigeration can trigger this syndrome. If patients go out in cold weather, they should dress warmly with many layers. Wearing a hat is essential.
- Living in a warm climate may help relieve symptoms, although a recent study found that weather changes themselves had little effect on the disorder.
- Exercise is helpful for maintaining a sense of well-being, keeping warm, and sustaining skin flexibility. Patients with Raynaud's phenomenon may want to avoid exercising outdoors in cold weather, however.
- Quitting smoking is, of course, essential for anyone, but it is critical for people with scleroderma.
- Learning relaxation and anti-stress techniques might help reduce some triggers of Raynaud's phenomenon.
- Using moisturizers and antibiotic ointments may be helpful for keeping skin flexible and preventing infections in the fingers.
- Avoiding medications such as nonselective beta blockers (for example, propranolol), certain common cold preparations, and narcotics can reduce the risk of aggravating Raynaud's phenomenon.
Medications Used in the Treatment of Raynaud's Phenomenon
Vasodilators. Vasodilators open blood vessels and so are important for Raynaud's phenomenon.
Calcium-channel blockers, including diltiazem (Cardizem, Dilacor) and nifedipine (Adalat, Procardia) are the standard vasodilating drugs used for Raynaud's phenomenon. Nifedipine is the best studied of these drugs, but there are also newer dihydropyridines, including felodipine, amlodipine, and isradipine.
Nitrates, available in topical or oral forms, are vasodilators that are also used for Raynaud's phenomenon, and for short-term relief.
Prostacylins. Iloprost and other prostacylins are proving to be effective agents for Raynaud's phenomenon. Small but well done studies seem to show these drugs to be helpful for this condition, and possibly as effective as calcium channel blocker drugs such as nifedipine. Evidence shows that intravenous iloprost given at progressively increasing doses over 3-month cycles can reduce the duration and frequency of attacks. In general, these drugs are used when a patient's symptoms are severe, particularly when the doctor is considering amputating a finger.
Endothelin receptor agonists have also been shown to help with Raynaud's phenomenon.
PDE5 Inhibitors. Recently approved PDE5 inhibitors, which include sildenafil (Rovatio) and tadalafil (Adcirca), help improve symptoms and blood flow, and speed ulcer healing in patients with Raynaud's phenomenon. This treatment for ulcer healing is still experimental, but is approved for pulmonary hypertension. Under different names (Viagra, Cialis), these drugs are also used to treat erectile dysfunction.
Surgical Treatments for Problems of the Hands
Sympathectomy and Hand Surgeries. Sympathectomy uses procedures that block or remove the nerve responsible for narrowing blood vessels in the hand. The result is increased blood flow in the hand.
The local anesthetics lidocaine or bupivacaine may be very effective in temporarily restoring blood flow and reducing pain.
For finger ulcers that won't heal and are resistant to standard treatments, sympathectomy surgery may be done.