We were interested to read the review article by Dr Neumeister titled, The Role of Botulinum Toxin in Vasospastic Disorders of the Hand. The paper provided a thorough summary of Raynaud phenomenon, including the history of the disorder, associated conditions, clinical features and the various therapies currently used. The crux of the article outlines how botulinum toxin is a promising treatment for patients with Raynaud phenomenon, especially those who have failed pharmacological therapy.

The author points out the need to further understand the mechanism of action botulinum toxin may have in these cases. This would help identify patients who would likely benefit. The author also highlights further work necessary to elucidate the doses that may be required. The evidence base that has been put forward consists of five case series (level IV evidence). It is unclear how a literature search was conducted for the article, although we could not find any controlled trials on the use of botulinum toxin in Raynaud’s in the literature. It would be useful to look into the relative efficacy of botulinum toxin compared to conventional pharmacological treatment and have robust evidence for its use, but to date this chapter summarised current understanding of the role of botulinum toxin in vasopasm of the hand.

The role of botulinum toxin in vasospastic disorders of the hand.
Neumeister MW.
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Kevin Beatson

Department of Plastic Surgery, Department of Plastic Surgery, St John's Hospital of Howden, Livingston, UK.

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