{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:00:53Z","timestamp":1784696453433,"version":"3.55.0"},"reference-count":84,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T00:00:00Z","timestamp":1730419200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Raynaud\u2019s conditions of the hand, referred to commonly as Raynaud\u2019s phenomenon, both primary and secondary, represents a spectrum of disorders affecting the digits, characterised by recurrent episodes of vasospasm that result in a triad of symptoms: pain, pallor, and cyanosis. Various therapies, ranging from conservative hand therapy techniques to surgical sympathectomy, have been explored with inconsistent results. Recently, the local administration of botulinum toxin type-A (BTX-A) has re-emerged as a treatment option for this condition. This review delves into the mechanistic pathways of BTX-A therapy, optimal dosing concentrations, administration techniques, and its safety profile. A critical analysis of published studies to date demonstrates varied clinical efficacy of BTX-A in Raynaud\u2019s conditions based on patient-reported outcome measures and objective measures of outcomes assessment. Thus, in order to accurately assess the clinical effectiveness of BTX-A in future robust studies, this review emphasises the importance of streamlining patient selection to minimise heterogeneity in disease severity, optimising recruitment to ensure adequate statistical power, and establishing sensitive outcome measures to monitor response and discern treatment efficacy. Additionally, addressing concerns such as minimising antibody resistance, extending the duration of treatment effects on tissues, and exploring new modalities to assess hand perfusion will be focal points for future research and BTX-A drug development.<\/jats:p>","DOI":"10.3390\/toxins16110472","type":"journal-article","created":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T09:49:14Z","timestamp":1730454554000},"page":"472","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Botulinum Toxin for the Treatment of Raynaud\u2019s Conditions of the Hand: Clinical Practice Updates and Future Directions"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7323-1454","authenticated-orcid":false,"given":"Patrick","family":"O\u2019Donohoe","sequence":"first","affiliation":[{"name":"Department of Plastic & Reconstructive Surgery, St. Vincent\u2019s University Hospital, D04T6F4 Dublin, Ireland"},{"name":"Department of Surgery, Royal College of Surgeons in Ireland, D02YN77 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jake","family":"McDonnell","sequence":"additional","affiliation":[{"name":"Department of Surgery, Royal College of Surgeons in Ireland, D02YN77 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Wormald","sequence":"additional","affiliation":[{"name":"Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX1 2DJ, UK"},{"name":"Department of Plastic & Reconstructive Surgery, John Radcliffe Hospital, Oxford OX3 9DU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lylas","family":"Aljohmani","sequence":"additional","affiliation":[{"name":"Department of Plastic & Reconstructive Surgery, St. Vincent\u2019s University Hospital, D04T6F4 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Cronin","sequence":"additional","affiliation":[{"name":"Department of Plastic & Reconstructive Surgery, Mater Misericordiae University Hospital, D07R2WY Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Durcan","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Beaumont Hospital, D09V2N0 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3343-2873","authenticated-orcid":false,"given":"Oran","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Tissue Engineering Research Group, Department of Anatomy & Regenerative Medicine, Royal College of Surgeons in Ireland, D02YN77 Dublin, Ireland"},{"name":"Trinity Center for Biomedical Engineering, Trinity College Dublin, D02PN40 Dublin, Ireland"},{"name":"Advanced Materials and Bioengineering Research Centre (AMBER), D02PN40 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0455-7343","authenticated-orcid":false,"given":"Roisin","family":"Dolan","sequence":"additional","affiliation":[{"name":"Department of Plastic & Reconstructive Surgery, St. Vincent\u2019s University Hospital, D04T6F4 Dublin, Ireland"},{"name":"UCD School of Medicine & Medical Sciences, University College Dublin, D04V1W8 Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1056\/NEJMra1507638","article-title":"Raynaud\u2019s Phenomenon","volume":"375","author":"Wigley","year":"2016","journal-title":"N. 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