Botulinum Toxin for Refractory Digital Ischemia and Ulcers in Systemic Sclerosis

What are the safety and effectiveness profiles of botulinum toxin (BTX) injections in treating acute digital ischemia, ischemic ulcers, and gangrene, particularly in patients with systemic sclerosis and other vasculopathies?In this systematic review and individual participant data meta-analysis of data from 119 patients, BTX injections were associated with high complete response rates for acute digital ischemia (93.1%), ischemic ulcers (90.1%), and digital gangrene (87.5%). Adverse events were infrequent, with transient muscle weakness (7.6%) and injection site pain (5.9%) being the most common.The study results suggest that BTX is a safe and effective adjunctive treatment for refractory ischemic digital complications, supporting its use as a physician-administered rescue therapy in autoimmune vasculopathies.

Corresponding Author: Elena Netchiporouk, MD, MSc, Division of Dermatology, McGill University, 1650 Cedar Ave, Montreal, QC H3G 1A4, Canada (elena.netchiporouk@mcgill.ca).

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