Pediatric Raynaud Phenomenon Treatment & Management

Updated: Jun 23, 2022
  • Author: Suzanne C Li, MD, PhD; Chief Editor: Lawrence K Jung, MD  more...
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Treatment

Medical Care

Patients with Raynaud phenomenon (RP) should avoid situations and stressors that aggravate the disease (eg, vibration, cold exposure, digital trauma). [5]  Patients should avoid medications and drugs that aggravate the disease (eg, smoking, cocaine, other medications listed above).

Patients need to adequately cover themselves in cold weather by covering core areas (head, trunk) and extremities using hats, layers, mittens, thick socks, and boots. Patients should come in from the cold when they feel a change in digit sensation or when prolonged pallor or cyanosis of the extremities occurs.

Digital wounds should be carefully treated and monitored. Clean wounds twice daily with soap and water, cover with a topical antibiotic ointment (eg, bacitracin, mupirocin [Bactroban]) and then with a light bandage. [5] Systemic antibiotics may be required if the infection worsens. Digital ulceration should be treated in a similar fashion. [5]

The feet should be evaluated for any problems; approximately 10% of adult patients with systemic sclerosis have foot ulcers. [7]

Biofeedback was reported to enable a pediatric patient to raise her digit temperature by 12o C and to aid some adult patients. [1, 17] Trials of biofeedback have yielded mixed results with some reporting benefits and others not. Part of the issue may be that biofeedback can be slow to learn so lack of efficacy may be partly related to patients failing to learn to do it effectively. [7, 5, 81, 82]

Auricular electroacupuncture was reported to decrease the frequency and severity of attacks in primary Raynaud phenomenon patients in an uncontrolled study. [83]

Low-level laser irradiation has also been reported to significantly reduce the frequency and severity of attacks in primary Raynaud phenomenon and secondary Raynaud phenomenon compared with sham irradiation. [84]

Botulinum toxin injection, typically in the vicinity of the palmar digital neurovascular bundle, has been used in both primary and secondary Raynaud syndrome. Improvement in symptoms and healing of digital ulcers has been reported. In one study, some patients derived long-term benefit from a single treatment, whereas in patients with systemic sclerosis, repeat treatments were administered after an average of 6 months. [85, 86]

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Surgical Care

Surgical care is needed for serious morbidity problems, including the following [7, 87] :

  • Debridement of necrotic tissue, including infected wounds and osteomyelitis, may be necessary.

  • Amputation of gangrenous digit may be required.

  • Different surgical techniques have been used to improve Raynaud phenomenon symptoms, including balloon angioplasty, venous or arterial grafting, and digital or thorascopic sympathectomy. [88, 82] Sympathetic block can help improve blood flow and is useful for threatened severe digit ischemia. [29]

  • Sympathectomy may be required for intractable ischemia not responsive to medical treatment. Digital artery sympathectomy is more commonly advised compared with cervical sympathectomy because of lower morbidity. [7, 89]

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Consultations

A pediatric rheumatologist should be consulted to evaluate patients suspected of having or developing secondary Raynaud phenomenon.

Other subspecialists, such as a hematologist, oncologist, or endocrinologist, should be consulted if the underlying condition for Raynaud phenomenon falls in their domain.

Consultation with a surgeon may be needed for patients with threatened digit ischemia.

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Diet and Activity

Diet

No specific diet recommendations are necessary.

Supplements such as fish oil and evening primrose have been reported to be beneficial in limited studies, but additional trials are needed for better evaluation of the effectiveness of these products. [29, 90]  In placebo-controlled trials, neither gingko biloba nor St. John’s Wort were found to provide any significant efficacy. [87]

Activity

Patients should carefully monitor symptoms in situations that may precipitate an episode.

If the patient is involved in winter sports, limiting the duration of continuous cold exposure, wearing layers, and using hand warmers may help.

In the spring and fall seasons, outdoor activity may also precipitate episodes during damp or rainy days. [9]

Patients who participate in activities that may result in digital injury (eg, skateboarding, mountain biking) should wear protective gloves to minimize abrasions and deeper injuries.

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