For primary Raynaud phenomenon, the first line of therapy consists of lifestyle measures, such as avoidance of precipitating factors and use of gloves. If these prove inadequate, the patient may be considered for calcium channel blocker treatment; nifedipine is the usual choice. Topical nitroglycerin (1% or 2%) has been found to help if applied locally, based on a limited number of controlled studies.

Therapy for secondary Raynaud phenomenon must be tailored to the underlying disorder. If the disorder is associated with occupational or toxic exposure, the patient should avoid the inciting environment.

Patients with hyperviscosity syndromes and cryoglobulinemia improve with treatments that decrease the viscosity and improve the rheologic properties of their blood (eg, plasmapheresis). Unfortunately, patients with Raynaud phenomenon associated with autoimmune disorders do not usually respond well to therapy. Hepatitis B, hepatitis C, and Mycoplasma infections need to be addressed, if present.

Patients with secondary Raynaud phenomenon should also use lifestyle measures. However, these patients are more likely to require pharmacologic therapy than are patients with primary Raynaud phenomenon.

Pharmacologic options for secondary Raynaud phenomenon include calcium channel blockers and prostacyclin analogues. Other agents may be considered; however, in a meta-analysis of interventions for secondary Raynaud phenomenon by Huisstede et al, solid evidence for therapies beyond calcium channel blockers and the prostacyclin analogue iloprost was lacking.

 Thank you for your answer, very informative.  Would either iloprost or sildenafil aggravate any underlying disease? 

It is greatly depend on patient illness history and condition, what disease  do you mean anything in particular? 

"Advances in the treatment of Raynaud’s phenomenon"

This article may be helpful.

Regards

Thank you.  I meant if there was a known connection e.g. scleroderma can't be used with e.g. sildenafil.  Do you think botox is a valid treatment for Raynaud's?