We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
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.
Text Size: A A A
Published online


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.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Graphic Jump Location

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.

Place holder to copy figure label and caption
Graphic Jump Location

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).




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

7 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Raynaud's phenomenon. Best Pract Res Clin Rheumatol 2016;30(1):112-32.