Digital Ulcers Associated with Systemic Sclerosis Successfully Treated with Botulinum Toxin A in Nine Patients

Abstract

Background: Digital ulcers (DUs) associated to systemic sclerosis is a frequent complication and causes morbidity, decreased quality of life and risk of surgical interventions.

Treatment is multi disciplinary but involves sufficient wound care and medical therapies.

We here report a case series of 9 patients with systemic sclerosis with painful DUs who either did not respond sufficient on conventional therapy or had contraindications for medication due to side effects or co morbidity before surgery intervention.

Method: A combination therapy with blockade of local analgesics and following botulinum toxin A (BTA) or only BTA around the nerves and vessels in the hands and feets where the DU was present was administered in aseptic technique. The effect was rated due to the patient’s report of pain on a visual analogue score and by the physician observing signs of healing and documented by photos.

Results: We only observed transient side effects but the treatment was well tolerated and with a good outcome on the healing the DUs, preventing amputations and markedly decreases in pain.

Conclusion: Though further studies are needed we suggest the treatment with a combination of local analgesics and BTA may be offered to systemic sclerosis patients with severe DUs, when conventional therapy with vasodilators are insufficient and if there is a risk of auto or doctor initiated amputation.