Management of severe Raynaud's phenomenon

Severe Raynaud's phenomenon is manifested by recurrent painful attacks often associated with digital ulcers, ischemic demarcation and amputation. Usually, a secondary disease process can be defined as a cause of severe Raynaud's phenomenon. Principles of management include treating the events as a medical emergency, carefully diagnosing and treating the underlying cause and instituting both nondrug and drug treatment early, before ischemic tissue damage occurs. Calcium channel blockers are currently the most effective oral vasodilator therapy for Raynaud's phenomenon. In some refractory cases, digital sympathectomy, fibrinolytic therapy, or infusion of prostanoids have been used with success. Understanding the complex pathogenesis of severe Raynaud's phenomenon will lead to new approaches to management in the future.