{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T03:34:18Z","timestamp":1789788858186,"version":"4.0.1"},"reference-count":12,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,2,25]]},"abstract":"<jats:p>Raynaud\u2019s 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\u2019s phenomenon in the toes, secondary to scleroderma. The diagnosis of Raynaud\u2019s 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\u2019s attacks. The effects were reported to last up to 5\u2009months. To our knowledge, these are the first reported cases of the treatment of Raynaud\u2019s phenomenon in the toes with botulinum toxin A.<\/jats:p>","DOI":"10.1136\/bcr-2017-219348","type":"journal-article","created":{"date-parts":[[2018,3,10]],"date-time":"2018-03-10T07:35:14Z","timestamp":1520667314000},"page":"bcr-2017-219348","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["The novel use of botulinum toxin A for the treatment of Raynaud\u2019s phenomenon in the toes"],"prefix":"10.1136","volume":"2018","author":[{"given":"Kiran","family":"Dhaliwal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Griffin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P","family":"Denton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter E M","family":"Butler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,3,9]]},"reference":[{"key":"2025042703031298000_2018.mar09_2.bcr-2017-219348.1","doi-asserted-by":"crossref","unstructured":"Flavahan NA . Pathophysiological regulation of the cutaneous vascular system in raynaud\u2019s phenomenon. New York: Springer, 2015.","DOI":"10.1007\/978-1-4939-1526-2_5"},{"key":"2025042703031298000_2018.mar09_2.bcr-2017-219348.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2010.09.019"},{"key":"2025042703031298000_2018.mar09_2.bcr-2017-219348.3","doi-asserted-by":"publisher","DOI":"10.1177\/1753193413516242"},{"key":"2025042703031298000_2018.mar09_2.bcr-2017-219348.4","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1097\/SAP.0b013e31825c078d","article-title":"The effect of botulinum toxin B pretreatment to the blood flow in the microvascular anastomosis","volume":"72","author":"Park","year":"2014","journal-title":"Ann Plast Surg"},{"key":"2025042703031298000_2018.mar09_2.bcr-2017-219348.5","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1002\/art.40123","article-title":"The therapeutic efficacy of botulinum toxin in treating scleroderma-associated raynaud\u2019s phenomenon: a randomized, double-blind, placebo-controlled clinical trial","volume":"69","author":"Bello","year":"2017","journal-title":"Arthritis Rheumatol"},{"key":"2025042703031298000_2018.mar09_2.bcr-2017-219348.6","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1007\/s40674-014-0006-z","article-title":"Management of Raynaud\u2019s phenomenon and digital ulcers","volume":"1","author":"Wigley","year":"2015","journal-title":"Curr Treatm Opt Rheumatol"},{"key":"2025042703031298000_2018.mar09_2.bcr-2017-219348.7","doi-asserted-by":"crossref","first-page":"1710","DOI":"10.1016\/j.jvs.2013.03.012","article-title":"Current medical and surgical management of Raynaud\u2019s syndrome","volume":"57","author":"Landry","year":"2013","journal-title":"J Vasc Surg"},{"key":"2025042703031298000_2018.mar09_2.bcr-2017-219348.8","first-page":"1788","article-title":"A systematic review of the outcomes of digital sympathectomy for treatment of chronic digital ischemia","volume":"30","author":"Kotsis","year":"2003","journal-title":"J Rheumatol"},{"key":"2025042703031298000_2018.mar09_2.bcr-2017-219348.9","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1053\/jhsu.1999.jhsu24a0173","article-title":"The use of digital artery sympathectomy as a salvage procedure for severe ischemia of Raynaud\u2019s disease and phenomenon","volume":"24","author":"McCall","year":"1999","journal-title":"J Hand Surg Am"},{"key":"2025042703031298000_2018.mar09_2.bcr-2017-219348.10","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1097\/01.prs.0000178795.21651.cc","article-title":"Digital sympathectomy of the lower extremity: a novel approach to toe salvage","volume":"116","author":"Agarwal","year":"2005","journal-title":"Plast Reconstr Surg"},{"key":"2025042703031298000_2018.mar09_2.bcr-2017-219348.11","doi-asserted-by":"publisher","DOI":"10.1177\/1753193412439170"},{"key":"2025042703031298000_2018.mar09_2.bcr-2017-219348.12","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1590\/S0102-865020150090000009","article-title":"Botulinum toxin type A on cutaneous flap viability in diabetic and tobacco-exposed rats","volume":"30","author":"Camargo","year":"2015","journal-title":"Acta Cir Bras"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2017-219348","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T10:03:21Z","timestamp":1745748201000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2017-219348"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3,9]]},"references-count":12,"alternative-id":["10.1136\/bcr-2017-219348"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2017-219348","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3,9]]}}}