Botulinum toxin type A in the treatment of Raynaud's phenomenon

J Hand Surg Am. 2010 Dec;35(12):2085-92. doi: 10.1016/j.jhsa.2010.09.019.


Purpose: Raynaud's phenomenon is a vasospastic disorder of the palmar and digital vessels of the hand and feet that can lead to ischemic ulcers, pain, and loss of function. This study is a review of patients I have injected with botulinum toxin type A for patients with Raynaud's phenomenon.

Methods: Raynaud's patients were injected with 50 to 100 units of onabotulinumtoxinA to improve perfusion of the digits. An institutional review board-approved retrospective review was undertaken to analyze outcomes. Laser Doppler scans were performed before and after injection to quantitatively measure perfusion.

Results: A total of 14 men and 19 women with Raynaud's phenomenon were injected with onabotulinumtoxinA. All but 5 patients experienced improved vascularity and relief of pain. Laser Doppler scans illustrated notable improvement in perfusion. Five patients had repeat injections for recurrent pain.

Conclusions: Botulinum toxin appears to improve perfusion of the hand after direct injection around the neurovascular bundles. Further investigations are warranted to identify the exact mode of action in relieving vasospasm and alleviating pain.

MeSH terms

  • Botulinum Toxins, Type A / pharmacology
  • Botulinum Toxins, Type A / therapeutic use*
  • Contraindications
  • Female
  • Hand / blood supply
  • Humans
  • Laser-Doppler Flowmetry
  • Male
  • Neuromuscular Agents / pharmacology
  • Neuromuscular Agents / therapeutic use*
  • Raynaud Disease / drug therapy*
  • Retreatment
  • Synaptosomal-Associated Protein 25 / physiology
  • Treatment Outcome


  • Neuromuscular Agents
  • Synaptosomal-Associated Protein 25
  • Botulinum Toxins, Type A