Efficacy of Botulinum Toxin A in Adult Subjects With Raynaud Phenomenon Secondary to Systemic Sclerosis

Inclusion Criteria: * Aged 18 years and older * Diagnosed with systemic sclerosis (EULAR/ACR 2013 criteria ; or Leroy and Metsger criteria). * Symptoms of Raynaud's phenomenon affecting both hands (not necessarily to equal extents) * Frequency of Raynaud's attacks ≥ 5/week during cold weather * Stable dose of phosphodiesterase inhibitors (sildenafil, tadalafil or vardenafil), endothelin antagonists, or calcium channel blockers defined as 1-month with no change in dose * Ability to return/be available for follow-up evaluations * Ability to fill the diary * Ability/willingness to give informed consent * Affiliation to any French social security regime Exclusion Criteria: * History of myasthenia gravis or Eaton Lambert syndrome * Inflammatory myositis \<2 years or pre-existing motor neurone disease or upper limb motor neuropathy * Reported allergy or hypersensitivity to any Botulinum toxin preparation or to lidocaine or other local anesthetic agent or to albumin or to inhaled nitrous oxide/oxygen. * Active infection in either hand. * Pregnant or lactating women (women of child bearing potential must undergo a urine pregnancy teste before inclusion and at treatment day). * women of child bearing potential without medically accepted method of birth control * Patients who have previously undergone any vascular surgery on the upper extremity, including surgical sympathectomy or ever received botulinum toxin or planned to receive botulinum toxin in the next 6 months * Cognitive im…