Raynaud's Phenomenon.
Raynaud's phenomenon may be primary (idiopathic) or secondary. Primary Raynaud's phenomenon is very common in young women, especially in cool climates. Treatment of patients with primary disease is usually much more successful than treatment of patients with secondary disease. Most patients respond to conservative measures. Reassurance that they will not lose digits or limbs is helpful. They should avoid instigating vasospastic attacks, which are usually caused by cold plus pressure on the digits. Reflex sympathetic vasoconstriction can be avoided by wearing warm clothing, including hats. Mittens are more protective than gloves, which separate the fingers. Many patients find chemical hand and foot warmers very useful. Pavlovian conditioning and biofeedback may be helpful if the patient is willing to spend the time. Underlying disease should be treated or instigating causes avoided in secondary Raynaud's phenomenon. In the more severe cases of primary Raynaud's phenomenon as well as in secondary cases, drug therapy is often beneficial. Calcium entry blockers have yielded the best results. Forms of nifedipine with extended action should be prescribed; felodipine or isradipine can be tried if nifedipine cannot be tolerated owing to frequent side effects. When these drugs fail or are not tolerated, sympatholytic drugs (eg, prazosin, reserpine, guanethidine) have benefited some patients. We have not found nitroglycerin preparations to be of benefit. In severe digital ischemia that does not respond to drug therapy, digital artery sympathectomy may help heal digital ulcers. Cervicodorsal sympathectomy is not recommended for upper extremity symptoms, but lumbosacral sympathectomy will often cure vasospastic attacks of the toes.
Coffman
JD
Peripheral Vascular Section, Evans Memorial Department of Clinical Research and Department of Medicine, Boston University Medical Center, One Boston Medical Center Place, Boston, MA 02118, USA.