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Botox for Raynaud Phenomenon

Results of this treatment were surprisingly long lasting.

Raynaud phenomenon has been treated by vasodilation and surgical sympathectomy, often with unsatisfactory results. In this retrospective study, researchers analyzed results of Botox treatment in 19 patients with Raynaud phenomenon who presented with ischemic pain, ulcerations of the fingertips (14 patients), poor capillary refill (>8 seconds), livedo reticularis, and nonpalpable digital pulses. They received injections of 50–100 U of Botox (diluted to a concentration of 5 U/mL) around the neurovascular bundle, at the level of the metacarpophalangeal joints in each hand. In 14 patients, laser Doppler perfusion data were obtained before and immediately after injection.

Pain relief was immediate in 13 patients and gradual over 1 to 2 months in another 3. Three patients had no relief of pain. The ulcers in all 13 patients with ulcers healed within 2 months of Botox injection (4 patients with exposed bone on presentation underwent partial amputation). Doppler scans showed increased blood flow within 30 minutes of injection in 10 of 14 patients and reduced blood flow in 3. Pain relief persisted in 12 of 19 patients at the last follow-up visit at 13 to 59 months. Two patients had temporary intrinsic finger muscle weakness. Of the three patients without pain relief, two had scleroderma and one had systemic lupus erythematosus.

Comment: This long-term response of Raynaud phenomenon to Botox is unexpected but promising. The only patients who did not benefit had relatively advanced connective tissue disease. The effect was so rapid that the mechanism of action must differ from the usual action at the acetylcholine vesicle, which takes up to a week to reach its full effect. If these initial findings are verified, the management of Raynaud phenomenon will be significantly altered for the better.

— George J. Hruza, MD

Published in Journal Watch Dermatology July 17, 2009

Citation(s):

Neumeister MW et al. Botox therapy for ischemic digits. Plast Reconstr Surg 2009 Jul; 124:191.

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• Pain Relief vs. Reduced Blood Flow
  Tony Brown, 29 Jul 2009 2:53 PM EST
  Very nice, Thank you. It would be interesting to know if there was any crossover between the three patients that... [more]
• Pain relief vs. reduced blood flow
  George J. Hruza, MD, Journal Watch Dermatology summary author, 29 Jul 2009 6:12 PM EST
  All 3 patients with no pain relief had increased blood flow by Doppler evaluation after Botox injection. Changes in perfusion... [more]