Care of the Skin in Raynaud's

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lovellWritten by Dr Christopher Lovell
Consultant Dermatologist, Bath    

MOISTURISERS/EMOLLIENTS
Ointments tend to be greasy. Creams are water-based, useful if the skin is moist or weepy, but may not be adequate for dry skin. Try to minimise use of soaps and bath salts. “Barrier creams” usually aren't!
Often “cheap and cheerful” moisturisers are as good as expensive “dermatologically tested” preparations in fancy bottles. The following are prescribable but, if you pay for prescriptions, some are cheaper bought over the counter. Examples include:

  • Emulsifying ointment BP. A mixture of waxes. One of the best and cheapest. Looks a bit like lard and rather stiff and hard to handle. Can be smeared on to skin before bathing or showering or rubbed between the hands under a running tap (don't burn yourself!) to create a frothy bath foam effect  Does not make the bath slippery.
  • Aqueous cream BP. In effect, emulsifying ointment mixed with water and a preservative. Easier to use as a soap substitute and make up remover but less value for money than emulsifying ointment!
  • Epaderm. A mixture of emulsifying ointment and white soft paraffin.  A bit more expensive but easier to rub on the skin than emulsifying ointment. Can also be used as soap substitute.
  • White soft paraffin/petroleum jelly or “vaseline”.. Rather sticky but quite a useful barrier if you're planning to swim the channel. In practice a 50:50 mixture of w.s.p. and liquid paraffin is easier to spread. You can make this mixture at home and adjust the proportions to taste!
  • Lanolin (wool alcohols). The raw stuff is a bit pongy and rather irritant. Hydrous ointment BP contains wool alcohols and zinc oxide. Wool alcohols are the nearest thing to human sebum and are unjustly neglected. Allergy to purified lanolin is VERY rare (some people claim it doesn't exist).
  • Unguentum M. A useful preparation halfway between a cream and an ointment. Pongs a bit.
  • Diprobase cream and Doublebase cream come in  dispenser packs, particularly useful in the workplace or by the sink. Other creams include Oilatum cream, E45 cream and Aveeno cream.
  • There are many oils which can be used in the bath or shower but they DO make them slippery. They include Oilatum bath oil (Oilatum Plus contains an added antiseptic), E45 bath oil (the cheapest to buy over the counter), Balneum oil (soya based, perfumed). Dermol 500/200 are thick lotions which can be used in the bath/shower; mildly antiseptic.


CONTROLLING ITCHING
Treat dry skin with moisturisers as above and if there is eczema use a topical steroid ointment sparingly but regularly.

  • Eurax cream (available over the counter.) can relieve itch. Other preparations include menthol (1/2-2%) in aqueous cream and Balneum Plus oil and cream. Some people find E45 anti-itch cream and witch hazel lotion to be helpful.
  • Local anaesthetic creams (e.g. lanacaine) are sometimes used but carry a strong risk of sensitisation.
  • Xepin cream (an antihistamine cream) carries a similar risk.
  • Antihistamines by mouth, e.g. Piriton (chlorpheniramine) can be helpful but can cause drowsiness (careful when driving).
  • Other treatments include Ultraviolet light treatment.


CARE OF SORES/ULCERS

  • Unless the wound is messy it is often best to protect it and interfere as little as possible. Keep digits as warm as possible and (of course!) don't smoke. Thin hydrocolloid dressings, e.g. Granuflex/Duoderm can be left on for several days and tolerate some wetting.
  • Alginate (“seaweed”) dressings (e.g. Sorbsan/Kaltostat)  can be useful for weeping wounds. Topical antiseptics/antibiotics such as Polyfax are sometimes used.
  • Calcium deposits (calcinosis) can sometimes be treated surgically or with lasers. Many drugs have been tried.


CARE OF THE NAILS
Don't fiddle too much with the cuticles; there is a risk of nail bed infection.
Onycholysis (freeing of the ends of the nails) is common in Raynaud's but often reversible. Keep the nails trimmed and filed. Try not to poke too much under the free edge of the nail. Don't use the nail as a lever!


SUN PROTECTION
Sun creams are never as good as they claim. Go for ones that have UVA (star rating) as well as UVB protection. Be sensible - try to avoid midday sun. Don't rely on “shade” especially near water Light clothing which doesn't let light through is much better than sunscreen. Protect car windows with, e.g. Dermaguard (Bonwyke films: 01329 289621).