Botulinum Toxin Evaluated in Digital Ischemia
Individual-level meta-analysis examines response, dosing, and safety across ischemic etiologies
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By
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Kathryn Wighton
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April 3, 2026
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Objective:
To evaluate the efficacy and safety of botulinum toxin in treating digital ischemia, ulcers, and gangrene.
Key Findings:
- 93% complete response in acute digital ischemia, 90% in ulcers, and 88% in gangrene.
- Fastest improvement in acute ischemia (mean 12 days), followed by gangrene (25 days) and ulcers (54 days).
- 91 of 101 patients with ulcers achieved complete reepithelialization.
- Adverse events were uncommon, with transient muscle weakness in 8% and injection site pain in 6%.
Interpretation:
Botulinum toxin shows high efficacy and safety in treating digital ischemia, particularly in autoimmune-related conditions.
Limitations:
- Reliance on small, heterogeneous studies.
- Variation in dosing and injection techniques.
- Incomplete individual-level data for approximately 40% of studies.
- Underpowered subgroup analyses for gangrene.
Conclusion:
Botulinum toxin demonstrates high efficacy and safety in treating digital ischemia, ulcers, and gangrene, especially in autoimmune-mediated disease.
