Treatment of Raynaud Phenomenon with BOTOX
You've probably heard of BOTOX treatment for the movie stars trying to puff up their lips or hide wrinkles and other signs of aging. Maybe you've even considered having it done yourself. In this report we find out about the use of BOTOX (BOTOX stands for botulinum neurotoxin) for another condition that doesn't have anything to do with your looks but affects hand function: Raynaud phenomenon.

What is Raynaud phenomenon? When the small blood vessels of the hands tighten up and close off, the blood supply can get cut off to the fingers. These spasms come and go in response to cold temperature or strong emotion. This condition is what we refer to as Raynaud phenomenon.

Patients with Raynaud phenomenon commonly suffer from pain and loss of function. Sometimes they can't even reach inside a refrigerator without gloves to protect their fingers. The loss of blood to the fingertips can cause ulcers to form. Patients who depend on their hands for work may be forced to change jobs.

Treatment for this condition varies from patient-to-patient. Sometimes physical therapy, acupuncture, and medications help. Creams applied to the skin to open the blood vessels can be used. Patients with this problem are encouraged to avoid cold conditions and stop using tobacco products. In cases that don't respond to these methods, surgery may be needed.

Cutting the nerve to the arteries that bring blood to the area may be an option. The outermost layer of the blood vessel is stripped away. This works because it removes the nerve control that is causing the arteries to go into spasm. This is the treatment recommended most often for patients with Raynaud and ulcers that don't heal. The result can be relief from pain and freedom from having to wear gloves.

Now BOTOX injections might be a less invasive and more effective treatment than surgery that disrupts blood vessels. It still works by turning off pain messages sent along tiny nerves in the hands but without having to cut the blood vessels or nerves directly. How well does it work? Who can have this treatment? How long does the pain relief last? These are a few of the questions answered in this article.

The information presented is based on small studies involving a few patients. There aren't large studies available yet. The use of BOTOX for this problem is still considered "off-label" and experimental. Off label means the drug is used for something other than what it was intended for. The Food and Drug Administration (FDA) has not approved the use of BOTOX for Raynaud phenomenon.

The treatment is effective though and that's why it's used for patients who have not responded well to other conservative measures and who have now developed finger ulcers. The risk of gangrene and amputation is too high to just let the problem go untreated. BOTOX works because it delivers a toxin to the body fluid around the nerves and blood vessels.

Except for some local pain where the needle is inserted, this treatment has very few (if any) negative side effects. Injections can be repeated every four-to-six months (that's about how long the effects last). Painful symptoms are decreased or gone and hand function is much better. But the effects may not last or provide a long-term (permanent) solution. The long-term effects of BOTOX injections for Raynaud phenomenon have not been investigated or reported yet either.

There are some patients who may not be good candidates for this type of approach for their Raynaud condition. For example, if they have tried BOTOX before and didn't tolerate it well or got no results, then a second series of injections isn't likely to help either. If the disease is too far progressed and there's no hope the blood vessels can be repaired, then BOTOX may not be a good idea.

Patients considering BOTOX injections for Raynaud phenomenon should be warned of possible adverse effects of this treatment. Skin infections, inability for the skin to cool itself by sweating (called anhydrosis), and muscle paralysis contributing to hand weakness have been reported.

For many patients hampered by Raynaud phenomenon, a minimally invasive treatment approach may be a welcome option. With good pain control providing improved hand function, BOTOX may be worth taking the chance of potential side effects.
Sandeep Mannava, MD, et al. Recent Advances for the Management of Raynaud Phenomenon Using Botulinum Neurotoxin A. In The Journal of Hand Surgery. October 2011. Vol. 36A. No. 10. Pp. 1708-1710.