Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2018 Mar 9:2018:bcr2017219348.
doi: 10.1136/bcr-2017-219348.

The novel use of botulinum toxin A for the treatment of Raynaud's phenomenon in the toes

Kiran Dhaliwal  1   2 , Michelle Griffin  1   2 , Christopher P Denton  3   4 , Peter E M Butler  1   2
Affiliations
Case Reports

The novel use of botulinum toxin A for the treatment of Raynaud's phenomenon in the toes

Kiran Dhaliwal et al. BMJ Case Rep. .

Abstract

Raynaud's phenomenon is a vasospastic disorder of the digital vessels triggered by exposure to cold or stress. It is most commonly observed in the hands, but also frequently affects the toes. We present three cases of patients with severe Raynaud's phenomenon in the toes, secondary to scleroderma. The diagnosis of Raynaud's syndrome and scleroderma was established according to the 2010 American College of Rheumatology and European League Against Rheumatism criteria. Patients were treated with 10 units of botulinum toxin injected into each foot. Two millilitres was injected into the base of each toe in both the left and right feet. Six weeks postinjection into the toes, patients reported an improvement of cold intolerance, colour change and frequency and severity of Raynaud's attacks. The effects were reported to last up to 5 months. To our knowledge, these are the first reported cases of the treatment of Raynaud's phenomenon in the toes with botulinum toxin A.

Keywords: plastic and reconstructive surgery; rheumatology.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Patient 1 (A) Pre-Btx-A injection, (B) 6 weeks post-Btx-A injection. Btx-A, botulinum toxin A.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Flavahan NA. Pathophysiological regulation of the cutaneous vascular system in raynaud’s phenomenon. New York: Springer, 2015.
    1. Neumeister MW. Botulinum toxin type A in the treatment of Raynaud’s phenomenon. J Hand Surg Am 2010;35:2085–92. 10.1016/j.jhsa.2010.09.019 - DOI - PubMed
    1. Uppal L, Dhaliwal K, Butler PE. A prospective study of the use of botulinum toxin injections in the treatment of Raynaud’s syndrome associated with scleroderma. J Hand Surg Eur Vol 2014;39:876–80. 10.1177/1753193413516242 - DOI - PubMed
    1. Park BY, Kim HK, Kim WS, et al. . The effect of botulinum toxin B pretreatment to the blood flow in the microvascular anastomosis. Ann Plast Surg 2014;72:214–9. 10.1097/SAP.0b013e31825c078d - DOI - PubMed
    1. Bello RJ, Cooney CM, Melamed E, et al. . The therapeutic efficacy of botulinum toxin in treating scleroderma-associated raynaud’s phenomenon: a randomized, double-blind, placebo-controlled clinical trial. Arthritis Rheumatol 2017;69:1661–9. 10.1002/art.40123 - DOI - PMC - PubMed

Publication types

MeSH terms

Substances