title: Botulinum toxin A in the treatment of Raynaud's phenomenon: a systematic review.
abstract: BACKGROUND
  The management of Raynaud's phenomenon in its most severe form is challenging, and current medical and surgical treatment methods frequently do not lead to optimal symptom control and prevention of ischemic complications. The aim of the study was to critically evaluate all existing evidence on the use of botulinum toxin A in the management of Raynaud's phenomenon.
  
  
  METHODS
  We adopted the PRISMA methodology and searched Cochrane Library, MEDLINE, SCOPUS, EULAR and ACR congresses abstract archives for Raynaud* AND botulinum toxin OR onabotulinum. All studies that contained reports of botulinum toxin A use and its outcome in Raynaud's phenomenon were included in the review.
  
  
  RESULTS
  Eleven studies met our inclusion criteria and involved a total of 125 patients. Two reviewers extracted data from the studies under review and achieved a consensus in their selection. The main outcomes measured were pain reduction and healing of digital ulcers. The level of evidence across studies was very low to moderate.
  
  
  CONCLUSIONS
  There is insufficient evidence to assess the efficacy of botulinum toxin A in Raynaud's phenomenon. Despite many promising reports, further research in the form of randomized controlled trials is warranted in order to investigate this new treatment method for Raynaud's phenomenon.
authors.affiliation: Department of Rheumatology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Żebryk
authors.affiliation: Department of Rheumatology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Mariusz J
authors.initials: MJ
authors.lastname: Puszczewicz
keywords: Raynaud disease/etiology/therapy; botulinum toxins; scleroderma; systemic/*therapy; type A/therapeutic use; vasodilator agents/therapeutic use