Contemporary Management of Raynaud’s Phenomenon

Raynaud’s phenomenon (RP) is defined as reversible pallor, and also rubor or cyanosis especially digits and it is very common on the general population. It can be an early sign of a connective tissue disease, especially scleroderma and may negatively impact patients’ quality of life. Lifestyle modifications including smoking cessation, cold-avoidance, and avoidance of medications that could worsen RP should be considered as first-line therapies. For those who are resistant to conservative measures, dihydropyridine calcium channel blockers (CCBs) are the preferred first-line treatment. The majority of treatment trials in RP study nifedipine, but other drugs such as amlodipine and felodipine. Otherwise, there is evidence supporting the use of topical nitrates and oral phosphodiesterase type 5 (PDE5) inhibitors. Intravenous prostaglandins (prostacyclins, PGI2 such as iloprost and PGE1 which is alprostadil) can be used for refractory cases. There remains a paucity of data for the benefit of botulism toxin, fluoxetine, or bosentan for treating RP in these patients.