Abstract

The initial management of Raynaud’s phenomenon includes the same panel of initial pharmacological agents according to the current guidelines for treating the condition, regardless of primary Raynaud’s disease or secondary Raynaud’s phenomenon, also recognized as Raynaud’s syndrome. The current pharmacological therapies show different efficacy in treating primary Raynaud’s disease compared to secondary Raynaud’s phenomenon. These pharmacological therapies reduce ischemia and increase blood flow via various mechanisms, including inhibiting calcium influx, providing exogenous vasodilating nitric oxide, elongate cGMP life, or increasing cAMP. The article explains the mechanism of reportedly more significant benefits of nitric oxide-related drugs in treating secondary Raynaud’s phenomenon. Due to complicated and unknown mechanisms underlying secondary Raynaud’s phenomenon, more small-scale clinical trials with other vasodilators have been conducted, for example, soluble guanylyl cyclase activator or sympathetic vasoconstriction inhibitors. The article also discusses two classes of drugs that seemed promising initially, however, failed in an early stage of clinical trial in terms of efficacy. In patients with refractory or progressive Raynaud’s phenomenon, an innovative regenerative therapy with autologous fat tissue or fat tissue-derived stromal vascular fraction is under clinical investigation. The article aims to inspire to discover new drug targets and develop novel therapy, which differentially treats the condition for better management when the exact pathophysiology is not well understood.