Acral Necrosis in a COVID-19-Infected Man Treated with Botulinum Toxin Type A

COVID-19 has been associated with acral ischemia and digital necrosis. Standard treatment of acral ischemia and digital or acral necrosis includes ongoing therapy with vasodilators and anticoagulants. However, these treatments are not always efficient to avoid the progression of necroses, which in the worst case can lead to amputation. Here, we report a case in which interdigital Botox^® (botulinum toxin type A) nerve cord injection stopped the progression of acral necroses arising from an underlying vasculopathy due to COVID-19. Moreover, Botox^® injection eliminated inflammation in the affected acral area within 2 weeks. This is the first case report to suggest Botox^® injection as a new and improving treatment for acral necroses due to COVID-19.