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The Cutting Edge: Challenges in Medical and Surgical Therapies |

Botulinum Toxin-A for the Treatment of Raynaud Syndrome

Lauren Smith, MD; David Polsky, MD, PhD; Andrew G. Franks Jr, MD
Arch Dermatol. 2012;148(4):426-428. doi:10.1001/archdermatol.2011.1144.
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Extract

Raynaud syndrome is a vasospastic disorder of the fingers, toes, and other body sites often associated with exposure to cold temperatures or emotional stress.13 Although responses to pharmacologic therapies are helpful, some cases are recalcitrant, leading to persistent pain and ulceration.

Correspondence: Andrew G. Franks Jr, MD, The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, Tisch H-100, 550 First Ave, New York, NY 10016 (Andrew.Franks@nyumc.org).

Accepted for Publication: August 18, 2011.

Author Contributions: All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Smith, Polsky, and Franks. Acquisition of data: Smith and Franks. Analysis and interpretation of data: Smith, Polsky, and Franks. Drafting of the manuscript: Smith and Franks. Critical revision of the manuscript for important intellectual content: Smith, Polsky, and Franks. Administrative, technical, and material support: Smith, Polsky, and Franks. Study supervision: Polsky and Franks.

Financial Disclosure: None reported.

Additional Contributions: We thank Carolina Kowalczyk, BA, for preparation and technical assistance with the manuscript. Bruce Stroeber, MD, PhD, Aieska DeSouza, MD, and Angela Hu, BA, were the statisticians.

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Figure 1. Notable improvement in digital blood flow following administration of botulinum toxin-A. A, Injection of botulinum toxin-A into the web spaces (red dots) and around neurovascular bundles (black dots). B, Doppler flow analysis of the left index finger before treatment with undetectable blood flow (arrowhead) and initial movement artifact (arrow). C, Marked improvement of blood flow with visible dicrotic notch (arrowheads) on Doppler flow analysis of the same finger 30 minutes after botulinum toxin-A injection.

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Figure 2. Digital ulcers on the left second digit before treatment (A) with complete resolution of ulcers 3 months after botulinum toxin-A injection (B). Five digital ulcers on the right hand before treatment (C) followed by complete resolution of ulcers on the first and third (distal ulcer) digit and partial resolution of the ulcers on the second and third (proximal ulcer) digits 3 months after botulinum toxin-A injection. No improvement of the digital ulcer on the fifth digit was noted; however, integrity of the nail plate was maintained with complete resolution of pain (D).

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