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• Introduction
• Symptoms
• Causes
• Risk Factors
• Prognosis
• Diagnosis
• Treatment
• Medications
• Other Treatments
• Treatment for Raynaud's Phenomenon
• Treatment for Skin Thickening
• Treatment for Lung Complications
• Treatment for Gastrointestinal Problems
• Treatment for Other Complications
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• References

Scleroderma

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of scleroderma.

Alternative Names

Systemic sclerosis

Treatment for Raynaud's Phenomenon

The following are some lifestyle tips for managing Raynaud's phenomenon:

• Keeping warm is the primary goal for preventing the onset of Raynaud's phenomenon. Air-conditioning and exposure to refrigeration can trigger this syndrome. If patients go out in cold weather, they should dress warmly with many layers. Wearing a hat is essential.
• Living in a warm climate may help relieve symptoms, although a recent study found that weather changes themselves had little effect on the disorder.
• Exercise is helpful in maintaining a sense of well-being, in keeping warm, and in helping to sustain skin flexibility. Patients with Raynaud's phenomenon may want to avoid exercising outdoors in cold weather, however.
• Quitting smoking is, of course, essential for anyone, but it is critical for people with scleroderma.
• Patients might want to learn relaxation and anti-stress techniques, which might help reduce some triggers of Raynaud's phenomenon. Many effective methods are available.
• Moisturizers and antibiotic ointments may be helpful for keeping skin flexible and preventing infections in the fingers.
• Patients should avoid certain medications that could aggravate Raynaud's phenomenon, including nonselective beta blockers (e.g., propranolol), certain common cold preparations, and narcotics.

Medications Used in the Treatment of Raynaud's Phenomenon

Vasodilators. Vasodilators open blood vessels and so are important for Raynaud's phenomenon. Some studies reporting their effects including the following:

• Calcium-channel blockers, including diltiazem (Cardizem, Dilacor) and nifedipine (Adalat, Procardia) are the standard vasodilating agents used for Raynaud's phenomenon. Side effects vary among different preparations, and may include fluid accumulation in the feet, constipation, fatigue, impotence, gingivitis, flushing, and allergic symptoms. Grapefruit juice appears to boost the effects of these drugs.
• Nitrates, available in forms that are topical or taken by mouth, are vasodilators that are also used for Raynaud's phenomenon. For example, in a 2002 study, a nitroglycerin tape improved circulation within an hour. A gel containing nitric oxide was found effective in a 1999 study in improving the blood circulation in hands and arms of Raynaud's patients. A single application increased circulation to the arms 10-fold, tripled the circulation to the fingers, and caused no serious side effects.

Prostacylins. Iloprost and other prostacylins are proving to be effective agents for Raynaud's phenomenon. A 2001 analysis reported that intravenous iloprost was effective for treating Raynaud's phenomenon, reduced the frequency of attacks, and prevented and healed ulcers. The form of iloprost taken by mouth was not as effective. One earlier comparison study found that iloprost was even more effective than the calcium channel blocker nifedipine.

Anti-Platelet Drugs. Aspirin, dipyridamole, and other drugs that prevent blood clotting and keep blood flowing freely are sometimes recommended to patients with Raynaud's phenomenon.

Estrogen Therapy in Women. Short-term treatment with estrogen may benefit older women with Raynaud's phenomenon and scleroderma. It is important to note, however, that hormone replacement therapy can increase a woman's risk for breast cancer, heart attacks, strokes, and blood clots.

• Review Date: 12/14/2006
• Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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