Botulinum toxin in vasospastic disorders of the hand
Botulinum toxin type A (BTX-A) is a new and effective therapy that can increase oxygenation, promote healing and reduce pain for patients with Raynaud's phenomenon, scleroderma, CREST syndrome, systemic lupus erythematosus, rheumatoid arthritis, Sjogren's syndrome, Buerger's disease (Thromboangitis Obliterans) and other vasospastic disorders.
How it works
The therapy is performed as an office procedure and involves injections of 50-100 units of BTX around the neurovascular bundles in the hand. While it is not known exactly how the BTX creates its therapeutic effect, it is thought to mimic a sympathectomy, modulating the vascular and neural abnormalities of the vasospastic disorder to reduce spasm and improve blood flow.
While the effect of the BTX is temporary (4-6 months), the effect of the increased blood flow can last much longer and the duration of treatment effect has been reported at 13-59 months. If a patient has ulceration and pain of the digits the injections may allow complete healing of the ulcers and resolution of the pain. It takes a lesser amount of oxygenation and blood flow to maintain healthy skin, compared to the amount of oxygenation and blood flow that is required to heal ulcerated, infected or damaged tissues.
This therapy should be used in conjunction with other conservative and medical therapies, such as smoking cessation, regular moisturiser, hand protection, appropriate wound management, and medications as directed by your rheumatologist.
Potential complications include weakness of the small muscles of the hand and pain at the injection sites.
Smoking and vasospastic disorders of the hand
If you have a vasospastic disorder of the hand it is imperative that you stop smoking. Smoking significantly reduces the blood flow to the hand. Just one cigarette is doing you major damage - a single cigarette can reduce blood flow to the fingers by 42% and cause cutaneous vasoconstriction for up to 90 minutes. The nicotine in cigaretes not only causes vasoconstriction, but smoking increases carboxyhaemoglobin, increases platelet aggregation, increases blood viscosity, decreases prostacyclin formation and decreases collagen deposition - all of which reduces healing.
It's not easy to give up smoking, please contact the professionals at Quit Victoria on 13 78 48 and keep trying until you succeed.
If you are not convinced that smoking cessation is necessary please read Brandon's story.