While there is no cure for Raynaud's, treatments can reduce the number of episodes and the severity of those episodes. Lifestyle changes such as reducing exposure to stress, certain chemicals and medicines, and repetitive actions may help manage Raynaud's. Also, those affected can reduce exposure to cold temperatures by wearing warm clothing during cold months, modifying air conditioning settings and dressing in layers during warmer months, and using gloves or mittens when taking food out of the freezer or refrigerator. Other lifestyle changes and activities that may help avoid an attack include:  

• Increasing physical activity to increase blood flow and help keep warm
  
  
• Limiting intake of caffeine and alcohol, limiting use of tobacco products and exposure to secondhand smoke
  
  
• Massaging or wiggling fingers and toes and moving arms in circles to increase blood flow
  
  
• Warming hands or feet with warm water or wearing gloves and heavy socks
  
  
• Protecting feet and hands from injury and dryness
  
  
• If possible, moving to a warmer climate

If lifestyle changes do not control Raynaud's, medicines or surgery may be necessary. In rare cases, individuals with severe Raynaud's may develop gangrene, which is the death or decay of body tissue. Severe cases may require antibiotics and surgery to remove dead tissue. Surgery can be done to cut and block the nerves that go to the hands or feet that control the narrowing of the arteries; however, this procedure may only relieve symptoms for a few years. (1) 

Medications

Medicines for Raynaud's are used to improve blood flow to the toes and fingers. These include prescription skin creams, calcium channel blockers (such as Procardia®), alpha blockers (such as Flomax®), and ACE inhibitors (such as Lotensin®). Additionally, injections may be used to block the nerves that control the narrowing of the arteries in the hands or feet.

Tests and Procedures

A physician begins by taking a patient's medical history and identifying risk factors for Raynaud's. Risk factors for primary Raynaud's include:

• Female gender—women account for about 80 percent of patients with Raynaud's disease
  
  
• Age under 30
  
  
• Family history of Raynaud's
  
  
• Living in a cold climate

Risk factors for secondary Raynaud's include:

• Age above 30
  
  
• Certain diseases and conditions, especially autoimmune diseases and those that directly damage arteries or the nerves that control arteries in the feet and hands
  
  
• Exposure to certain chemicals and medications
  
  
• Occupations that require repetitive actions of the hands or use of vibrating tools and machinery
  
  
• Injuries to the hands and feet
  
  
• Living in a cold climate

Next, the physician will ask if the individual experiences any symptoms in the hands or feet such as tingling or whiteness when exposed to cold temperatures. The medical history is followed by a physical exam where the physician checks the health of the skin covering the hands and feet and the blood flow to these areas of the skin and nails. During the exam, the physician may also check for signs of the underlying conditions linked to Raynaud's by recommending tests for these conditions. 

A cold stimulation test may be performed in order to trigger Raynaud's symptoms. In this test, a small device that measures temperature is taped to the individual's fingers and the hands are briefly placed in ice water. Once the hands are taken out of the ice water, the device measures the time it takes the fingers to return to their original temperature. For individuals with Raynaud's, it may take longer than 20 minutes to reach the original temperature. 

Another test that may be performed is the nailfold capillaroscopy test. In this test, a drop of oil is placed at the base of the fingernail and the fingernail is observed under the microscope. If the physician sees abnormal arteries, it may be an indication of an underlying condition linked to Raynaud's such as scleroderma. (1)

Treatment and Prevention

Once you become familiar with your Raynaud's patterns, you will be able to avoid its triggers. For example:

• In the winter, keep out the cold by wearing heavy socks and mittens, which hold in the warmth better than gloves.
  
  
• Slip on gloves before reaching into the freezer at home or at the store.
  
  
• Avoid taking decongestants; check out other medications you take with your doctor to make sure they don't trigger symptoms too.
  
  
• Avoid nicotine and caffeine, which cause blood vessels to constrict.

In one study, researchers found low levels of selenium and vitamin C in the blood of women with Raynaud's disease. Vitamin C levels were particularly low in smokers. It's too soon, though, for researchers to make any recommendations about vitamin C intake as a treatment or preventive for Raynaud's disease. (3)

How Supplements Can Help

Raynaud's disease is often a chronic condition, so supplements do the most good when taken daily.

Magnesium is known for its many benefits to the cardiovascular system and a deficiency in this mineral has been shown to cause coronary spasm. In one small study, individuals received intravenous magnesium over a period of twenty minutes. The magnesium dilated the coronary arteries. Although studies have not been done specifically for Raynaud's disease, the dilation effect of magnesium observed on coronary arteries may occur and be beneficial on the peripheral arteries of the hands and feet. (4)  

Inositol hexaniacinate is a relative of the B vitamin niacin that stimulates blood flow in the arms, fingers, legs, and toes. Though it improves circulation, this form of niacin does not cause the unwelcome flushing associated with regular niacin. (5)

The herb ginkgo biloba is known for its ability to open the smallest blood vessels. Look for a version that is standardized to contain at least 24% flavone glycosides. (6-9)

In one study, 21 individuals who received 12 capsules per day of evening primrose oil (EPO) showed improvement in Raynaud's symptoms after two weeks. However, EPO did not improve blood flow. (10) You can use evening primrose oil by itself or in combination with other supplements.

Fish oil supplements may work if other supplements don't. In one small test, people taking fish oil were symptom-free for 15 minutes longer than those not taking it. (11) If you have diabetes, speak with your doctor about the dosage. High doses can affect blood sugar levels.

Self-Care Remedies

Be especially careful to avoid injury to areas that are prone to Raynaud's disease.

Because fish oil has been shown to help, try to eat oily fish (salmon, mackerel, tuna, sardines) at least twice a week.

Alternative Therapies

Biofeedback and other Behavioral Therapies such as self-hypnosis may help control temperature and may be effective therapies in the treatment of Raynaud's. In one study, 67% of 313 study participants learned to control their ability to warm their hands. (12) Biofeedback may be used in conjunction with other treatment or as an alternative treatment for those who do not want to undergo conventional drug therapy for Raynaud's disease. (13)

When to Call a Doctor

• If the skin becomes tight, shiny or smooth in affected areas
  
  
• If tiny sores develop in affected areas
  
  
• If a person loses dexterity or becomes numb during an attack
  
  
• If any Raynaud's symptoms become more frequent or severe

References

1. National Heart Lung and Blood Institute. Website. Available at http://www.nhlbi.nih.gov/health/dci/Diseases/raynaud/ray_what.html -Accessed December 18, 2010.
2. García-Carrasco M, Jiménez-Hernández M, Escárcega RO, Mendoza-Pinto C, Pardo-Santos R, Levy R, Maldonado CG, Chávez GP, Cervera R. Treatment of Raynaud's phenomenon. Autoimmun Rev. 2008 Oct;8(1):62-8. Epub 2008 Aug 8.
3. Herrick AL, Rieley F, Schofield D, Hollis S, Braganza JM, Jayson MI. Micronutrient antioxidant status in patients with primary Raynaud's phenomenon and systemic sclerosis. J Rheumatol. 1994 Aug;21(8):1477-83.
4. Teragawa H, Kato M, Yamagata T, Matsuura H, Kajiyama G. The preventive effect of magnesium on coronary spasm in patients with vasospastic angina. Chest. 2000 Dec;118(6):1690-5.
5. Inositol hexaniacinate. Altern Med Rev. 1998 Jun;3(3):222-3.
6. Pittler MH, Ernst E. Ginkgo biloba extract for the treatment of intermittent claudication: a meta-analysis of randomized trials. Am J Med 2000;108:276-81.
7. Schweizer J, Hautmann C. Comparison of two dosages of ginkgo biloba extract EGb 761 in patients with peripheral arterial occlusive disease Fontaine's stage IIb. A randomised, double-blind, multicentric clinical trial. Arzneimittelforschung 1999;49:900-4.
8. Peters H, Kieser M, Holscher U. Demonstration of the efficacy of ginkgo biloba special extract EGb 761 on intermittent claudication—a placebo-controlled, double-blind multicenter trial. Vasa1998;27:106-10.
9. Bauer U. 6-Month double-blind randomised clinical trial of Ginkgo biloba extract versus placebo in two parallel groups in patients suffering from peripheral arterial insufficiency. Arzneimittelforschung1984;34:716-20.
10. Belch JJ, Shaw B, O'Dowd A, Saniabadi A, Leiberman P, Sturrock RD, Forbes CD. Evening primrose oil (Efamol) in the treatment of Raynaud's phenomenon: a double blind study. Thromb Haemost. 1985 Aug 30;54(2):490-4.
11. DiGiacomo RA, Kremer JM, Shah DM. Fish-oil dietary supplementation in patients with Raynaud's phenomenon: a double-blind, controlled, prospective study. Am J Med. 1989 Feb;86(2):158-64.
12. Middaugh SJ, Haythornthwaite JA, Thompson B, Hill R, Brown KM, Freedman RR, Attanasio V, Jacob RG, Scheier M, Smith EA. The Raynaud's Treatment Study: biofeedback protocols and acquisition of temperature biofeedback skills. Appl Psychophysiol Biofeedback. 2001 Dec;26(4):251-78.
13. Birger M, Sha'anani R, Pavlotzki F. Biofeedback treatment of Raynaud's disease. Harefuah. 1997 Nov 2;133(9):362-4, 414.