Thank you for this useful clinical review summarising the diagnosis and current management guidelines for Raynaud’s Phenomenon (RP). We would like to add to the options for conservative/nutritional management by highlighting the potential therapeutic benefits of using fish oils (n-3 fatty acids), as well as the need for further clinical research in this area. In view of evidence for the use of essential fatty acids (EFAs) in treating inflammatory disorders this may be of some use in reducing symptoms, attack duration and severity.[1] A number of intravascular factors are implicated in the cause of secondary RP and these may be mitigated by EFAs which may also reduce other associated cardiovascular risk factors in RP.[2] However, the meta-analysis included in your review by Malefant and colleagues suggests that Ginkgo Biloba as well as fish oils may afford some benefit, but also highlights the lack of recent and robust evidence in both instances, therefore necessitating further research.[3] Nutritional management constitutes a gap in current guidelines and is worthy of further attention as a potential adjuvant treatment option.

1. Belch, J.J.F. and A. Hill, Evening primrose oil and borage oil in rheumatologic conditions1. The American Journal of Clinical Nutrition, 2000. 71(1): p. 352S-356S.
2. Ho, M., et al., The beneficial effects of omega 3 and omega 6 essential fatty acid supplementation on red blood cell rheology. Prostaglandins, Leukotrienes and Essential Fatty Acids, 1999. 61(1): p. 13-17.
3. Malenfant, D., M. Catton, and J.E. Pope, The efficacy of complementary and alternative medicine in the treatment of Raynaud's phenomenon: a literature review and meta-analysis. Rheumatology, 2009. 48(7): p. 791-795.

Competing interests: None declared