Although, other studies also reveal that CCBs may be effective at decreasing severity of attacks, pain and disability associated with Raynauds phenomenon. People whose disease is secondary to erythromelalgia often cannot use vasodilators for therapy, as they trigger flares causing the extremities to become burning red due to too much blood supply. People with severe disease prone to ulceration or large artery thrombotic events may be prescribed aspirin. Sympatholytic agents, such as the alpha-adrenergic blocker prazosin, may provide temporary relief to secondary Raynauds phenomenon. Losartan can, and topical nitrates may, reduce the severity and frequency of attacks, and the phosphodiesterase inhibitors sildenafil and tadalafil may reduce their severity. Angiotensin receptor blockers or ACE inhibitors may aid blood flow to the fingers, and some evidence shows that angiotensin receptor blockers (often losartan) reduce frequency and severity of attacks, and possibly better than nifedipine. The prostaglandin iloprost is used to manage critical ischemia and pulmonary hypertension in Raynauds phenomenon, and the endothelin receptor antagonist bosentan is used to manage severe pulmonary hypertension and prevent finger ulcers in scleroderma. Statins have a protective effect on blood vessels, and SSRIs such as fluoxetine may help symptoms, but the data is weak. PDE5 inhibitors are used off-label to treat severe ischemia and ulcers in fingers and toes for people with secondary Raynauds phenomenon; as of 2016, their role more generally in Raynauds was not clear. Surgery
In severe cases, an endoscopic thoracic sympathectomy  procedure can be performed.
Skull bossing is a descriptive term in medical physical examination indicating a protuberance of the skull, most often in the frontal bones of the forehead ("frontal bossing"). Although prominence of the skull bones may be normal, skull bossing may be associated with certain medical conditions, including nutritional, metabolic, hormonal, and hematologic disorders. Frontal bossing
Frontal bossing is the development of an unusually pronounced forehead which may also be associated with a heavier than normal brow ridge. It is caused by enlargement of the frontal bone, often in conjunction with abnormal enlargement of other facial bones, skull, mandible, and bones of the hands and feet. Frontal bossing may be seen in a few rare medical syndromes such as acromegaly – a chronic medical disorder in which the anterior pituitary gland produces excess growth hormone (GH). Frontal bossing may also occur in diseases resulting in chronic anemia, where there is increased hematopoiesis and enlargement of the medullary cavities of the skull. Associated medical disorders
Rickets
Achondroplasia
Acromegaly
Basal cell nevus syndrome
Congenital syphilis
Cleidocranial dysostosis
Crouzon syndrome
Cryopyrin-Associated Periodic Syndrome (CAPS – PFS)
Ectodermal dysplasia
Extramedullary hematopoiesis
Fragile X syndrome
Hurler syndrome
Osteopathia Striata with Cranial Sclerosis
Pfeiffer syndrome
Rubinstein-Taybi syndrome
Russell-Silver syndrome (Russell-Silver dwarf)
Thanatophoric dysplasia
Talfan syndrome
Trimethadione (antiseizure drug) use during pregnancy
Beta-thalassemia (due to expansion of bone marrow secondary to increased hematopoiesis; see Extramedullary hematopoiesis)
Hallermann-Streiff syndrome


== References ==