Botulinum Toxin’s Use in Severe Vasospastic Disorders

ABSTRACT

This report presents three patients who were failing medical management and were referred for surgical intervention because of infracted or impending infarction of distal pulp skin and severe rest pain despite aggressive medical management. Follow-up is short, but the results are presented because of significant early results.

One patient had hyperhidrosis of the palm skin. Botulinum toxin A was used to ameliorate the sympathetic activity in the palm. Within 24 hours of injection, the patient’s hand stopped sweating, vascular flow dramatically improved, and perfusion of the pulp skin resulted in minor ulcer healing and ischemic pain relief. The results have persisted for 4 months after administering the toxin.

The two remaining patients have been followed for 2 months following injection and did not have hyperhidrosis; however, based on the first patient outcome they also were treated with Botulinum toxin A. Both patients have responded by increasing flow and decreasing pain. Necrosis was avoided in one patient and secondary healing after removing infracted tissue resulted in the other patient.

All 3 patients demonstrated decreased vasospastic attacks and all reported significantly less rest pain. The sites of injection, doses used, and longer-term follow up will be reported. This is the first known report using Botulinum toxin A for the management of severe vasospastic disorders.