Raynaud’s phenomenon (RP) results from severe spasms of the blood vessels of the fingers and toes when they are exposed to cold. There is an initial white phase caused by the lack of local blood flow. Next, the fingers look bluish and, then, red because of rapid flow back into the fingers. There is pain and tingling of the fingers. Some patients with severe symptoms of RP can develop skin lesions and, even, gangrene.
“Primary” RP is symmetric and usually mild. “Secondary” RP is more severe and is often secondary to an illness called systemic sclerosis. After 140 years of research, the cause of RP is still not known. Lifestyle changes required for treatment include avoiding the cold, stress, caffeine and smoking.
Treatments of RP include endothelin receptor antagonists, phosphodiesterase-5 inhibitors, medications that alter serotonin activity, angiotensin II receptor blockers, antioxidants, vasodilators and newer blood vessel dilators. Calcium channel blockers are the most commonly used pharmaceuticals. Prostaglandins, such as iloprost, have been shown to be of benefit. Topical nitroglycerin is undergoing some trials and shows some benefit in RP.
Phosphodiesterase inhibitors increase nitric oxide, relax the muscles of the blood vessel walls, allow dilation of the blood vessels and can relieve symptoms of RP. Symptomatic improvement has been seen in patients treated with sidenafil, a phosphodiesterase inhibitor.
CONCLUSION: Patients with primary RP must make lifestyle changes. Patients with secondary RP should make lifestyle changes and will probably need pharmaceuticals, such as calcium channel blockers, phosphodiesterase-5 inhibitors, prostaglandin derivatives, etc.
NOTE: Other studies have shown the benefit of arginine amino acid in symptomatic RP. Some patients have even recovered from necrosis of the fingers with the use of high dose arginine. See Rainbow Grocery Summary #158 (PMID: 17201823.)
Systemic sclerosis is known, also, as scleroderma.