THURSDAY, Dec. 11, 2025 (HealthDay News) -- Botulinum toxin (BTX) injections seem safe and effective for refractory digital ischemia in systemic sclerosis, according to a review published online Dec. 10 in JAMA Dermatology.

Catherine Zhu, M.D., from McGill University in Montreal, and colleagues examined the effectiveness and safety of BTX injections for ischemic digital complications and assessed predictors of response. Eligible studies included patients presenting with acute digital ischemia, ischemic digital ulcers, or gangrene; 119 patients were included in the systematic review and individual participant data meta-analysis.

The researchers found that BTX was associated with high rates of complete response for ischemia, ulcers, and gangrene (93.1, 90.1, and 87.5 percent, respectively). Adverse events occurred infrequently; the most common were transient muscle weakness and injection site pain (7.6 and 5.9 percent, respectively). In multivariable models, no associated factors reached statistical significance, but in Kaplan-Meier analyses, autoimmune etiology and younger age were associated with faster response.

"The results of this systematic review and meta-analysis suggest that BTX demonstrates high efficacy and safety in treating digital ischemia, ulcers, and gangrene, particularly in autoimmune-mediated disease," the authors write. "Its outpatient feasibility and economic advantages support consideration as an adjunctive therapy for refractory cases."

One author disclosed ties to the pharmaceutical industry.

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