Botulinum toxin A in the treatment of Raynaud’s phenomenon: a systematic review

Żebryk, Paweł; Puszczewicz, Mariusz

doi:10.5114/aoms.2015.48152

Cited by 24 publications

(24 citation statements)

References 26 publications

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“…[120][121][122][123] There is also increasing interest in botulinum toxin injection, which promote local arterial vasodilation. 124,125 However, at the present time, the evidence base is limited and further research is needed in this area. For example, in a recent double-blind, placebo-controlled, laboratory-based clinical trial, local injections of botulinum toxin did not significantly improve blood flow to the hands in patients with SSc-RP.…”

Section: Non-pharmacological Interventionsmentioning

confidence: 98%

Raynaud phenomenon and digital ulcers in systemic sclerosis

et al. 2020

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Raynaud's phenomenon (RP) is a symptom complex related to impaired digital perfusion and can occur as a primary phenomenon or secondary to a wide range of underlying causes. RP occurs in virtually all patients with systemic sclerosis (SSc) and is often the earliest clinical manifestation in the natural history of the disease. Careful assessment is required in RP patients to avoid missing secondary causes of RP, including SSc. Digital ulcers (DUs) are a painful and disabling visible manifestation of the digital vascular injury. Significant progress has been made in the definition and assessment of DUs and understanding ulcer pathogenesis. There are a wide range of available treatments to both prevent and heal DUs; some of which are also used in RP management. The present review shall consider the assessment of patients with RP, including 'red flags' suggestive of SSc. We shall review the pathogenesis, definition and classification across the spectrum of SSc-DU disease, alongside a review on management approaches including drug therapies and surgery for SSc-RP and ulcers. We also highlight unmet needs and research priorities in SSc-RP and SSc-DUs and introduce the concept of a unified vascular phenotype in which vascular therapies may support disease modification strategies.

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Section: Non-pharmacological Interventionsmentioning

confidence: 98%

Raynaud phenomenon and digital ulcers in systemic sclerosis

et al. 2020

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“…Niektóre prace [25,[29][30][31] wskazują na korzyści ze stosowania toksyny botulinowej (BTX-A) u pacjentów z niedokrwieniem palców, zarówno z towarzyszącym owrzodzeniem, jak i bez tego objawu [25]. Mechanizm działania BTX-A opiera się prawdopodobnie na zwięk-szaniu przepływu krwi i ograniczaniu bólu poprzez blokowanie oddziaływania układu współczulnego [29].…”

Section: Conflict Of Interestunclassified

“…Mechanizm działania BTX-A opiera się prawdopodobnie na zwięk-szaniu przepływu krwi i ograniczaniu bólu poprzez blokowanie oddziaływania układu współczulnego [29]. Iniekcje BTX-A są mniej inwazyjną metodą leczenia o niskim wskaźniku powikłań i stanowią skuteczną terapię alternatywną w przypadkach objawu Raynauda niereagujących na inne formy leczenia [30].…”

Section: Conflict Of Interestunclassified

“…The probable mechanism of action of BTX-A is increasing blood flow and reducing pain, by blocking the effect of the sympathetic nervous system [29]. BTX-A injections, as a less invasive treatment, with a low rate of complications, can be a good alternative for cases of Raynaud's phenomenon unresponsive to other forms of therapy [30].…”

Section: Raynaudamentioning

confidence: 99%

“…Some scientific reports mention [25,[29][30][31]] the benefits of the use of botulinum toxin A (BTX-A) in patients with digital ischaemia with or without ulceration [25]. The probable mechanism of action of BTX-A is increasing blood flow and reducing pain, by blocking the effect of the sympathetic nervous system [29].…”

Section: Raynaudamentioning

confidence: 99%

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Raynaud’s phenomenon as an interdisciplinary problem

Gorska¹,

Szczerkowska-Dobosz²,

Purzycka-Bohdan³

et al. 2017

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Raynaud's phenomenon is one of the most common disorders of the blood vessels, which usually affects fingers and toes. Raynaud's disease, also called primary Raynaud's phenomenon, is diagnosed when the cause is unknown, whereas Raynaud's syndrome or secondary Raynaud's phenomenon occurs as a skin manifestation of concomitant disease. The most common trigger is exposure to cold. Specific clinical features allow a quick diagnosis. Raynaud's phenomenon usually does not require pharmacologic treatment, but in some cases symptoms are severe and pharmacotherapy is necessary. Calcium channel blockers are usually used as a first-line treatment. Alternative forms of therapy include angiotensin-converting-enzyme inhibitors, α1-adrenergic blockers, phosphodiesterase-5 inhibitors, endothelin antagonists, nitrates, antioxidants, statins, botulinum toxin, and even autologous fat grafting. StReSzczeNieObjaw Raynauda jest jedną z najczęstszych reakcji skurczowych naczyń krwionośnych, zazwyczaj dotyczy palców rąk i stóp. Choroba Raynauda, inaczej zwana pierwotnym objawem Raynauda, jest rozpoznawana, gdy przyczyna schorzenia jest nieznana. Zespół Raynauda lub wtórny objaw Raynauda współtowarzyszy innym chorobom. Najczęstszym czynnikiem prowokującym skurcz naczyń jest ekspozycja na zimno. Charakterystyczny obraz kliniczny zwykle pozwala na szybkie ustalenia rozpoznania. Objaw Raynauda u większości chorych nie wymaga leczenia farmakologicznego, ale u niektórych osób objawy są nasilone i farmakoterapia staje się niezbędna. Leki z grupy antagonistów wapnia są często stosowane w leczeniu pierwszego rzutu. Alternatywne formy terapii obejmują: inhibitory konwertazy angiotensyny, leki α1-adrenergiczne, inhibitory fosfodiesterazy 5, antagonistów endoteliny, azotany, przeciwutleniacze, statyny, toksynę botulinową, a nawet autologiczne przeszczepy tkanki tłuszczowej.

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A Practical Approach to the Management of Digital Ulcers in Patients With Systemic Sclerosis

et al. 2021

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IMPORTANCE Digital ulcers (DUs) occurring on the fingers in patients with systemic sclerosis (SSc) are associated with substantial pain and disability and are often challenging to treat. However, careful clinical assessment and prompt intervention (wound bed management and systemic pharmacologic treatment) may modify the clinical course.OBJECTIVES To provide a practical approach to the assessment and management of SSc-DUs and highlight unmet needs and research priorities.EVIDENCE REVIEW A narrative review of the extant literature was undertaken to provide a broad overview of current knowledge and augmented by expert opinion.FINDINGS Half of the patients with SSc have a history of DUs, and there is a point of prevalence of approximately 10%. Digital ulcers are often very painful and affect all aspects of physical, social, and family life as well as occupation. Digital ulcers are associated with a severe disease course. Systemic sclerosis DUs, particularly those occurring on the fingertips, represent a vascular ischemic complication, although other etiopathogenic factors play an important role. To guide management, a structured clinical approach is required, including DU definition, classification, and categorization. Digital ulcers require a multidisciplinary approach with close cooperation between physicians and specialist nursing and other allied health professionals to guarantee the appropriate treatment and provide patient education. Local wound bed management is necessary for all DUs and is combined with systemic (pharmacologic) treatments. When treating a DU, the clinician should actively review the therapeutic strategy to prevent further DUs, including the level of systemic disease control, and monitor closely for the development of DU complications, including infection and progression to gangrene. Despite a wide available therapeutic armory, a number of unmet needs and challenges remain that that require resolution to optimize DU management. CONCLUSIONS AND RELEVANCEA practical approach to DU management, including local wound bed management and systemic treatments, is useful. Digital ulcers are of interest to a broad range of dermatologists, rheumatologists, and other physicians providing care for patients with SSc. Careful clinical assessment and prompt intervention can substantially modify the clinical course of DUs in SSc.

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Botulinum toxin A in the treatment of Raynaud’s phenomenon: a systematic review

Cited by 24 publications

References 26 publications

Raynaud phenomenon and digital ulcers in systemic sclerosis

Raynaud phenomenon and digital ulcers in systemic sclerosis

Raynaud’s phenomenon as an interdisciplinary problem

A Practical Approach to the Management of Digital Ulcers in Patients With Systemic Sclerosis

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