Arch Hand Microsurg.  2019 Sep;24(3):210-217. 10.12790/ahm.2019.24.3.210.

Botulinum A Toxin Injection as an Adjuvant Wintering Therapy in Patients with Raynaud's Syndrome

• Cho KS
• Yoon JS
• Ahn HC

• KMID: 2456244
• DOI: http://doi.org/10.12790/ahm.2019.24.3.210

Abstract

PURPOSE
Patients with secondary Raynaud's syndrome experience severe pain and even ulceration of the fingertips, particularly during the winter season. The aim of this retrospective review was to evaluate whether botulinum A toxin injection before the winter season could prevent severe pain and complications in patients with secondary Raynaud's syndrome.
METHODS
Patients (n=10) were injected with botulinum A toxin (25 U) at 14 points on each hand. Sex, age, number of treatments, underlying diseases, pre- and post-injection pain intensity and frequency, satisfaction with the injection, and complications were evaluated. Statistical analyses were performed using the Wilcoxon signed-rank test.
RESULTS
All patients had secondary Raynaud's syndrome and were female, with mean age of 50.1 years. All patients showed an improvement in pain intensity after the injection. The frequency of pain per week improved after the injection in seven patients and remained the same in three patients. The mean satisfaction rating was 7.0 out of 10 points. Eight patients were willing to reinject; however, two patients refused reinjection due to injectional pain. Two patients had temporary weakness of the hand. Seven patients showed an improvement in cyanosis. Nine patients showed an protectiv effects in fingertip ulcerations.
CONCLUSION
Botulinum A toxin injection in patients with secondary Raynaud's syndrome before the winter season may provide substantial improvements in pain and ulceration, as the pain increases during the cold season. Furthermore, the protective effect of botulinum A toxin may also be helpful in preventing additional surgery.

Keyword

Raynaud disease; Peripheral vascular diseases; Botulinum toxins, type A; Vasoconstriction

MeSH Terms

Botulinum Toxins, Type A*
Cyanosis
Female
Hand
Humans
Peripheral Vascular Diseases
Raynaud Disease
Retrospective Studies
Seasons
Ulcer
Vasoconstriction
Botulinum Toxins, Type A

Figure

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  Fig. 1. Botulinum A toxin (25 U) was injected in each hand at 14 points (black dots) based on the digit injection pattern.

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  Fig. 2. Questionnaire. VAS: visual analogue scale.

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  Fig. 3. The thermoscan images show a patient (left) at pre-injection and (right) at follow-up, 3 months after botulinum A toxin injection.

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  Fig. 4. (A) The graphs show the pain intensity visual analogue scale (VAS). Mean±standard deviation (SD) of pain intensity, pre- and post-injection (p<0.05). (B) The graphs show the pain frequency. Mean±SD of pain frequency, pre- and post-injection (p<0.05).

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  Fig. 5. The photographs show a patient (A) at pre-injection and (B) at follow-up, 6 months after botulinum A toxin injection.

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