The Role of Botulinum Toxin A in the Treatment of Raynaud Phenomenon

Abstract: Raynaud phenomenon (RP) is a transient digital ischemia that occurs after exposure to cold temperature or emotional distress. It presents with a triphasic course: the initial white phase is followed by cyanotic discoloration and, subsequently, erythema. The attacks may be associated with pain, paresthesia, and complicate with nonhealing ulceration often leading to amputation. To date, there are no clear-cut therapeutic guidelines and many medications are used off-label. Encouraging results were reported with the use of botulinum neurotoxin-A (BoNT-A). However, there is still ongoing debate regarding indications, contraindications, best injection technique, and mechanism of action. The aim of this study was to address these issues by providing an up-to-date and detailed overview of the use of BoNT-A in RP. A PubMed database search was conducted. The available studies and techniques were evaluated and compared. The search yielded a total of 29 studies. Ten papers, published between 2004 and 2014, were considered relevant. A total of 128 patients underwent BoNT-A injections. Seventy-five percent to 100 % of the patients reported pain reduction after treatment. Healing of ulcers was reported in 75% to 100% of the affected patients. The most common complication was temporary hand weakness, with an average incidence of 14.1%. Injections targeting the neurovascular bundle at or slightly proximal to the A1 pulley were the most commonly performed. Botulinum neurotoxin-A i...
Source: Annals of Plastic Surgery - Category: Cosmetic Surgery Tags: Peripheral Nerve Surgery and Research Source Type: research

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AbstractIntroductionSystemic sclerosis (SSc) is a connective tissue disease characterized by progressive fibrosis of the skin and internal organs, leading to their failure and disturbances in the morphology and function of blood vessels. The disease affects people in different ways, and identifying how the difficulties and limitations are related to quality of life may contribute to designing helpful interventions. The aim of this study was to identify factors associated with quality of life in people with SSc.MethodsThis was a cross-sectional study conducted in 11 rheumatic centres in Poland. Patients diagnosed with SSc w...
Source: Quality of Life Research - Category: Health Management Source Type: research
This study aimed to determine the effect of Btx-A injected via a dorsal approach.MethodForty patients received 100  units of Btx-A, injected across both hands via a dorsal approach. Each patient had a baseline, 6- and 12-week hand assessment and thermographic image (FLIR E60bx) performed for the study.ResultsEighty-eight percent of patients reported an improvement in symptoms including reduction in pain, improved colour change with reduced swelling and edema at 6  weeks. Of these patients, 80% reported an improvement in cold intolerance with a reduction in the frequency and severity of Raynaud’s attacks. Th...
Source: Clinical Rheumatology - Category: Rheumatology Source Type: research
We present our findings in the form of evidence maps.ResultsWe included 16 good-quality systematic reviews examining biofeedback alone or as an adjunctive intervention. We found clear, consistent evidence across a large number of trials that biofeedback can reduce headache pain and can provide benefit as adjunctive therapy to men experiencing urinary incontinence after a prostatectomy. Consistent evidence across fewer trials suggests biofeedback may improve fecal incontinence and stroke recovery. There is insufficient evidence to draw conclusions about effects for most conditions including bruxism, labor pain, and Raynaud ...
Source: Journal of General Internal Medicine - Category: Internal Medicine Source Type: research
Publication date: Available online 24 July 2019Source: Case Reports in Women's HealthAuthor(s): Jesus Avila Vega, Enrique Urrea-Mendoza, Christy LeeAbstractRaynaud's phenomenon of the nipple is an unusual side-effect of labetalol use. There is one official report from the United Kingdom. The present case concerns a 30-year-old woman, gravida 1, para 0, who developed pre-eclampsia and was treated with labetalol but subsequently reported neuropathic pain of the nipple. Nifedipine was then started as part of her treatment plan for blood pressure control and she no longer reported pain, despite being given six more doses of la...
Source: Case Reports in Womens Health - Category: OBGYN Source Type: research
To the Editor: I read with great interest the recent 2-part series by Waldman et  al, “Skin diseases of the breast and nipple.”1 I wish to highlight a common inflammatory condition that was briefly noted in the section on Candida mastitis, which is Raynaud phenomenon of the nipple (RPN). I believe this is an underdiagnosed and underreported cause of nipple pain in pregnant and lactating women and a treatable cause of inability to breastfeed.
Source: Journal of the American Academy of Dermatology - Category: Dermatology Authors: Tags: JAAD Online Source Type: research
Joseph D. Romano1,2,3,4 and Nicholas P. Tatonetti1,2,3,4* 1Department of Biomedical Informatics, Columbia University, New York, NY, United States 2Department of Systems Biology, Columbia University, New York, NY, United States 3Department of Medicine, Columbia University, New York, NY, United States 4Data Science Institute, Columbia University, New York, NY, United States The discovery of new pharmaceutical drugs is one of the preeminent tasks—scientifically, economically, and socially—in biomedical research. Advances in informatics and computational biology have increased productivity at many stag...
Source: Frontiers in Genetics - Category: Genetics & Stem Cells Source Type: research
Conclusion Trochlear pain (trochleodynia) is becoming recognized as a set of disorders that can present in isolation or concomitantly with co-existing migraines, tension-type headaches, or other headache disorders, possibly explaining subpar symptom control in a small but significant number of individuals globally. Trochleodynia features unilateral periocular pain that may involve the ipsilateral hemicranium. Pain exacerbation occurs with trochlear palpation and supraduction of the affected eye especially in the adducted position. Trochleodynia may respond to oral NSAIDs if symptoms are mild and of recent onset. While ora...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
This study aims to validate an ambulatory circadian monitoring (ACM) device for the detection of sleep and wake states and apply it to the evaluation of sleep quality in patients with Parkinson disease (PD). A polysomnographic validation study was conducted on a group of patients with different sleep disorders in a preliminary phase, followed by a pilot study to apply this methodology to PD patients. The ACM device makes it possible to estimate the main sleep parameters very accurately, as demonstrated by: (a) the lack of significant differences between the mean values detected by PSG and ACM in time in bed (TIB), total sl...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
CONCLUSION: Raynaud phenomenon of the nipple is an underdiagnosed condition affecting women in both the prenatal and postpartum periods. A careful history and physical must be obtained in women presenting with breast pain, because diagnosis and treatment allows breastfeeding continuation and mitigation of symptoms. PMID: 30969221 [PubMed - as supplied by publisher]
Source: Obstetrics and Gynecology - Category: OBGYN Authors: Tags: Obstet Gynecol Source Type: research
Conclusion: Despite still lacking a formal diagnosis, her constellation of symptoms is most likely the result of an atypical presentation of Raynaud ’s Disease.
Source: Medical Principles and Practice - Category: Internal Medicine Source Type: research
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