Management of Raynaud’s Phenomenon and Digital Ischemia

  • Ariane L. Herrick
Part of the following topical collections:
  1. Topical Collection on Scleroderma


This review focuses on new findings and developments relevant to the clinician caring for patients with primary and secondary [especially systemic sclerosis (SSc)-related] Raynaud phenomenon (RP). In the last 18 months, several clinical trials and observational studies of RP and of SSc-related digital ulceration have been published, reflecting increased awareness of disease burden and increased interest by pharmaceutical companies: new insights into pathophysiology are driving new approaches to treatment. Key developments are the increased use of phosphodiesterase type V inhibitors in severe RP, and of bosentan (an endothelin-1 receptor antagonist) for prevention of recurrent SSc-related digital ulcers. Other treatments being researched include topical glyceryl trinitrate (applied locally to the digits), botulinum toxin (for severe digital ischemia/ulceration), and several other drugs including oral prostanoids. Increased availability and interest in nailfold capillaroscopy, by facilitating early diagnosis of SSc, should pave the way for studies of early intervention and vascular protection.


Raynaud’s phenomenon Systemic sclerosis Digital ulcers Digital ischemia Critical ischemia Clinical trials Phosphodiesterase inhibitors Endothelin-1 receptor antagonists Glyceryl trinitrate Prostanoids Botulinum toxin Nailfold capillaroscopy Management 



Dr. Herrick has served as a consultant for Actelion Pharmaceuticals and Pfizer; has received royalties from UpToDate; has received payment for development of educational presentations (including service on speakers’ bureaus) from Actelion Pharmaceuticals; has had travel/accommodations expenses covered/reimbursed by Actelion Pharmaceuticals; and has been an investigator in studies sponsored by Actelion Pharmaceuticals, Pfizer, MediQuest, United Therapeutics Corp., and Orion Pharma.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation TrustUniversity of ManchesterSalfordUK

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