Background Raynauds phenomenon is an episodic vasospastic disorder, which manifests as triphasic colour change in response to stress or cold. The exact pathophysiology of Raynauds phenomenon is incompletely understood. As a result, targeting the underlying cause in pathogenesis of Raynauds phenomenon has proved challenging, driving the focus of pharmacological and surgical management options towards the crux of the issue. Most pharmacologic therapies target arterial vasoconstriction and consist of direct or indirect vasodilators, sympatholytics, Prostaglandins and anticoagulants. However, their effects are inconsistent and transient. Surgical options like sympathectomies have variable outcomes with inherent morbidities. Botulinum toxin type A, a neurotoxin has been tried with a good success in previous reports. We report the results of treatment of recalcitrant Raynauds phenomenon with Botulinum toxin type A in our Institution.
Objectives To study the role and efficacy of Botulinum toxin type A in the management of Raynauds phenomenon and healing of chronic digital ulcers that are recalcitrant to conventional pharmacological agents.
Methods 50 patients attending Rheumatology outpatient department of our institution with recalcitrant Raynauds phenomenon (frequent attacks, worsening pain, discolouration, non healing digital ulcers) secondary to systemic connective tissue disorders who were already on conventional drugs were recruited for the study after obtaining Institutional ethical board clearance.60 units of Botulinum type A toxin (12 sites per hand- 5 units per site) was reconstituted with 3ml of normal saline and injected along the digits, targeting the space adjacent to superficial palmar arch, common digital artery and proper digital arteries. Outcome was assessed by pain rating (visual analog scale), Quick DASH score, digital colour appearance, duration of healing of chronic digital ulcers, Colour and Power Doppler of digital arteries (resistive index, pulsatility index, peak systolic velocity, end diastolic velocity) before and after 30 days of Botulinum administration. All patients were followed up for 8 months.
Results In our study, Botulinum injection reduced the warm up time after exposure to cold, improvement in the pain visual analog scale and quick DASH score, improved Doppler findings (decreased resistive and pulsatility index, increase in the peak systolic and end diastolic velocity), reduction in the duration, intensity, severity of attacks.
Conclusions Hence we conclude that Botulinum administration is a relatively safe method to abort Raynauds attacks. It reduces the use of multiple drugs used in the treatment of Raynauds and its adverse effects. it also avoids cumbersome surgeries and improves the patients quality of life and activities of daily living.
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Kossintseva I, Barankin B. Improvement in both Raynaud disease and hyperhidrosis in response to botulinum toxin type A treatment. J Cutan Med Surg 2008; 12(4): 189–93.
Disclosure of Interest None declared
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