Interdigital injection of botulinum toxin for patients with Raynaud’s phenomenon

Journal Pre-proof Interdigital injection of botulinum toxin for patients with Raynaud’s phenomenon Lucía Quintana-Castanedo, Marta Feito-Rodríguez, Raúl De Lucas-Laguna PII:

S0190-9622(19)33208-6

DOI:

https://doi.org/10.1016/j.jaad.2019.11.060

Reference:

YMJD 14043

To appear in:

Journal of the American Academy of Dermatology

Received Date: 11 November 2019 Accepted Date: 18 November 2019

Please cite this article as: Quintana-Castanedo L, Feito-Rodríguez M, De Lucas-Laguna R, Interdigital injection of botulinum toxin for patients with Raynaud’s phenomenon, Journal of the American Academy of Dermatology (2020), doi: https://doi.org/10.1016/j.jaad.2019.11.060. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier on behalf of the American Academy of Dermatology, Inc.

Title: Interdigital injection of botulinum toxin for patients with Raynaud’s phenomenon.

Type of article: Surgical pearl

Authors: Lucía Quintana-Castanedo Marta Feito-Rodríguez Raúl De Lucas-Laguna

Founding sources: none Corresponding author: Lucía Quintana Castanedo Department of Dermatology, La Paz University Hospital, Madrid, Spain -

Mail address: Paseo de la Castellana 261, Z.C 28046 Madrid, Spain

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Email address: [email protected]

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Telephone number: +34 917277231

Affiliations of all authors: Department of Dermatology, La Paz University Hospital, Madrid, Spain. References: 2 Number of multimedia files (video): 1 Authors declare no conflict of interest Word count: 212 Keywords: botulinum toxin; Raynaud’s phenomenon

Title: Interdigital injection of botulinum toxin for patients with Raynaud’s phenomenon.

Botulinum toxin (BTX) injection has demonstrated to be a simple and costeffective option in terms of pain reduction, promoting healing digital ulcers and decreasing the frequency of vasospastic attacks in patients with Raynaud’s phenomenon. A universal injection technique and optimal dose to achieve adequate symptom control are lacking. Some of the reported procedures, such as proximal and distal palmar injection techniques, are painful and often require sedation or anaesthetic blockade. The interdigital technique is an alternative approach, well tolerated, which can be performed in outpatient basis without any type of anaesthesic management (video 1). BTX is diluted in 2,5ml of sterile normal saline solution and injections are performed using a 30 gauges-needle. A total of 36 IU of BTX are injected into each hand as follows: 8 IU into each finger web space sparing the thumb web space and 4 IU into each side of the thumb’s and the cubital aspect of fifth finger’s metacarpophalangeal joint. Our personal experience has taught us that by sparing the thumb web space, we can minimize the loss of strength in the pincer grasp without losing efficacy. The effect of BTX is long-standing, with a mean period of 10-12 months between subsequent injections, allowing an optimal symptom control with only one or two injections per year.

References: 1. Fregene A, Ditmars D, Siddiqui A. Botulinum toxin type A: a treatment option for digital ischemia in patients with Raynaud’s phenomenon. J Hand Surg Am. 2009;34(3):446-452. doi:10.1016/j.jhsa.2008.11.026

2. Żebryk P, Puszczewicz MJ. Botulinum toxin A in the treatment of Raynaud’s phenomenon: a systematic review. Arch Med Sci. 2016;12(4):864-870. doi:10.5114/aoms.2015.48152