New approach to treating finger ulcers, gangrene
- Allan Ryan
- 19 minutes ago
- 2 min read
Botulinum toxin may offer a practical new option for patients with painful, treatment‑resistant ischemic lesions of the fingers, according to a systematic review and individual‑patient meta‑analysis published in JAMA Dermatology by investigators at the McGill University Health Centre (MUHC) in Montreal.
Researchers at the Research Institute of the MUHC report that injections of botulinum toxin were associated with complete healing of digital lesions in more than 85% of 119 patients with acute digital ischemia, digital ulcers, and gangrene drawn from 30 published studies and one unpublished case. The treatment, administered locally to reduce vasoconstriction and improve blood flow, targets complications that are often refractory to conventional vasodilator and immunosuppressive regimens. These manifestations, frequently linked to systemic sclerosis but also seen in other autoimmune rheumatic diseases, vascular disorders, and drug‑induced vasculopathies, are a major source of pain, infection, tissue loss, and amputation risk.
“These new findings are particularly important because therapeutic options remain limited for the cutaneous and vascular manifestations of systemic sclerosis and other autoimmune diseases,” said Dr. Elena Netchiporouk in a press release. She is a dermatologist and scientist in the Infectious Diseases and Immunity in Global Health Program at the MUHC’s Research Institute and senior author of the study. Existing intravenous vasodilators and immunosuppressants are “often costly, minimally effective and associated with significant adverse effects,” she noted.
The analysis suggests that a single botulinum toxin session was often sufficient to achieve the desired response, with most adverse events described as mild and transient, typically short‑lived muscle weakness or injection‑site pain. Dr. Netchiporouk has been incorporating botulinum toxin injections into her clinical practice for the past four years to treat severe Raynaud’s phenomenon, acute digital ischemia, ischemic ulcers, and early-stage gangrene.
“Our results show that botulinum toxin can be used to improve blood circulation in the fingers and treat serious complications such as ulcers or gangrene, thereby offering a safe and easy‑to‑administer alternative,” said Dr. Catherine Zhu, a dermatology resident at the MUHC and first author of the study. She added that incorporating this outpatient procedure into rheumatology and dermatology practice could reduce reliance on inpatient intravenous therapies and lessen burdens on health care systems.