How to give cold comfort this winter

Most patients with Raynaud's phenomenon (RP) have relatively mild symptoms that can be managed by avoiding cold and other aggravating factors, such as cigarette smoking. Medication is recommended for patients whose condition fails to respond to nondrug therapy, those who have painful attacks, and those with RP that results from a serious underlying process or systemic disease (secondary RP). Vasodilators are the mainstay of treatment, and calcium channel blockers are the preferred agents. Prostaglandins are an option for patients with secondary RP. Reserve surgical sympathectomy for patients in whom medical treatment has failed and who continue to have ischemia or severe digit-threatening RP. An acute ischemic crisis requires early, aggressive intervention-with rapid control of vasoconstriction - to forestall the need for surgical amputation.