Treating Raynaud phenomenon

Symptoms of Raynaud phenomenon can be treated or significantly reduced, but not cured. As there is so much still to understand through clinical research regarding the cause of the condition, a cure is not yet available once diagnosed.

The biggest factor to take into consideration when it comes to treating Raynaud phenomenon relates to lifestyle changes which prevent the constriction of blood vessels as much as possible. This is necessary so as to avoid as much damage to skin tissue as possible. By minimising the frequency and severity of attacks, risk for damage is kept relatively low. In most primary cases, lifestyle changes are all the treatment that is needed. In secondary Raynaud phenomenon cases, treatment will focus on symptoms associated with underlying disorders or conditions, often including medications.

Lifestyle Adjustments

Lifestyle adjustments and considerations which may be mentioned by a doctor include:

• Avoiding triggers or aggravators such as smoking (including second-hand smoke) as this can lead to a hardening of the arteries (arterial disease). It is also best to limit alcohol and caffeine intake.
• Making efforts to stay as warm as possible at all times (all year round), especially the hands and feet. A drop in core body temperature can trigger a vasospasm attack. Headwear can help to minimise heat dissipation through the scalp (which helps to retain body heat). Dressing in layers may also make it easier to maintain ideal core body temperature. Polypropylene fabrics tend to keep moisture away from the body which can help to alleviate cooling. Clothing and footwear materials should be breathable and waterproof.
• Regular exercise can help to keep the body warm and also alleviate the intensity of a vasospasm attack by improving blood circulation and also helping to better manage stress. Windmill arm exercises (swinging the arms in circular motions at the sides of the body) can be good for getting blood circulation going. Those with secondary Raynaud phenomenon are advised to consult their doctor before attempting exercise outdoors in very cold weather. He or she can advise the best options according to the underlying disorder and associated symptoms.
• Soaking affected portions of the body in warm (not hot) water during a vasospasm attack can alleviate some symptoms.
• Ensuring that room temperatures in the home and place of work are not too cool if spending a considerable amount of time in the environment. This includes maintaining a comfortable temperature using air conditioners during the warmer months of the year. It is also wise to be mindful of sharp temperature changes – i.e. moving from a warm room to bitterly cold outside temperatures. Dressing in preparation for these sorts of changes can help alleviate risk of an attack.
• Avoid walking around barefoot too often so as to avoid dissipation of heat. Wearing socks at night, especially during the winter can also help. Merino wool or cashmere are natural, soft fibres which are great for keeping feet warm at night. Compression socks, although made to improve circulation, are not an ideal choice when lying down (as these may block blood flow).
• Foot powders applied to the feet can help to absorb moisture, alleviating dampness which can cause cooling.
• Avoid wearing tight-fitting footwear, wrist-bands or rings which can aggravate blood vessel constriction in the hands, feet, fingers and toes. Tight-fitting clothing should also be avoided.
• Take precautions when exposing affected portions of the body to temperature changes – use gloves when washing dishes or taking things out of a freezer.
• Where possible, especially when stress appears to trigger or aggravate symptoms, measures to reduce levels are advisable.

Medical treatment for Raynaud's syndrome

• Medications: Severe symptoms (i.e. intense vasospasm attacks which are long-lasting and / or frequent) can be treated with medication. Medications may be prescribed to relax blood vessels and thereby reduce attacks. Medication types a doctor may prescribe to help with this include vasodilators such as antidepressants, erectile dysfunction drugs or those used for antihypertension, as well as blood thinners (such as aspirin). An alpha blocker (alpha-1 blocker) can help to counteract the hormone norepinephrine, which can constrict blood vessels. A calcium channel blocker can also be prescribed to help increase blood flow to affected areas and heal skin ulcers. Medications which a doctor may limit or recommend avoiding altogether as they can worsen blood vessel constriction include oestrogen-based drugs, oral contraceptives (birth control pills), migraine medications, beta-blockers and pseudoephedrine-based medications for the treatment of colds, coughs or allergies. A topical nitroglycerin ointment can help to relax or widen blood vessels and can be prescribed for application on affected portions of the body for relief (i.e. improving blood flow). Before any medications are used, associated side-effects must be discussed with a doctor before commencing dosages. Some medications may not be taken during pregnancy due to their potentially adverse effects on a growing baby.
• Surgery: Where all else fails and symptoms are debilitating or causing a severe lack of blood circulation, a doctor may consider a sympathectomy procedure (or digital sympathectomy). This is a surgical procedure which works to interrupt the exaggerated response in the sympathetic nerves of the hands and feet. Small incisions (usually along the sides at the base of a hand or foot) help to better control the opening and closing (dilation and constriction) of tiny blood vessels in the skin by removing nerves around the capillaries (this is known as adventitial stripping). The aim is to reduce the intensity, frequency and duration of vasospasm attacks, but this is not always successful. Results can sometimes only provide temporary relief. It is best to weight up benefits and risks with the surgeon before opting to try the procedure. Generally, surgery is reserved for particularly complicated or severe conditions.
• Chemical injections: An alternative to surgery may involve frequent injections using local anaesthetics or onabotulinumtoxin type A (botulinum toxin type / botox). Injections may provide temporary relief by targeting the sympathetic nerves, effectively relieving constriction of the blood vessels / capillaries in the hands and feet. Benefits versus risks should also be discussed with the treating doctor before opting to commit to this route of treatment.