Raynaud's phenomenon.

Treatment of Raynaud's phenomenon in any one individual depends on the severity of symptoms and whether or not there is an underlying disease process requiring specific intervention. Many patients with primary (idiopathic) Raynaud's phenomenon respond well to treatment with general measures, perhaps with the addition of a calcium channel blocker. Conversely, others with underlying structural vascular abnormality (as occurs in connective tissue diseases such as systemic sclerosis ) are often refractory to treatment and may progress to irreversible tissue injury, sometimes with gangrene. Because these patients are the most challenging and because a large proportion of the research into Raynaud's phenomenon has been conducted in patients with SSc-spectrum disorders, much of this review is weighted toward them. The key principles of management are removal/treatment of any triggering factor/underlying cause, general (nondrug) measures, drug treatment, and surgery, although the last is rarely indicated. New insights into pathogenesis have led, and continue to lead, to new approaches to treatment, including endothelin-1 receptor antagonism and nitric oxide supplementation.