BMJ Case Reports 2018; doi:10.1136/bcr-2017-219348
  • Novel treatment (new drug/intervention; established drug/procedure in new situation)

The novel use of botulinum toxin A for the treatment of Raynaud’s phenomenon in the toes

  1. Peter E M Butler1,2
  1. 1UCL Centre for Nanotechnology and Regenerative Medicine, Royal Free Hospital, London, UK
  2. 2Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, UK
  3. 3Experimental Rheumatology Department, Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital, London, UK
  4. 4Division of Medicine, University College London, London, UK
  1. Correspondence to Dr Kiran Dhaliwal, kirandhaliwal50{at}
  • Accepted 25 February 2018
  • Published 9 March 2018


Raynaud’s phenomenon is a vasospastic disorder of the digital vessels triggered by exposure to cold or stress. It is most commonly observed in the hands, but also frequently affects the toes. We present three cases of patients with severe Raynaud’s phenomenon in the toes, secondary to scleroderma. The diagnosis of Raynaud’s syndrome and scleroderma was established according to the 2010 American College of Rheumatology and European League Against Rheumatism criteria. Patients were treated with 10 units of botulinum toxin injected into each foot. Two millilitres was injected into the base of each toe in both the left and right feet. Six weeks postinjection into the toes, patients reported an improvement of cold intolerance, colour change and frequency and severity of Raynaud’s attacks. The effects were reported to last up to 5 months. To our knowledge, these are the first reported cases of the treatment of Raynaud’s phenomenon in the toes with botulinum toxin A.


  • Contributors KD collected data and wrote the manuscript. MG helped design the project, collected data and reviewed the manuscript. CPD helped design and supervise the project. PEMB designed and supervised the project and reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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