Botox for hyperhidrosis

NewsBot · Oct 17, 2008

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Full text of this case report and discussion are available:

Treatment of recalcitrant plantar hyperhidrosis with type-A botulinum toxin injections and aluminum chloride in salicylic acid gel
Antranik Benohanian
Dermatology Online Journal 14 (2): 5

Case 1—a 32-year-old man was first seen on October 20, 2003 for a disabling plantar hyperhidrosis (HH) and bromhidrosis (BH) from which he suffered since his adolescence. Topical application of 55 percent aluminum chloride hexahydrate (AC) in 6 percent salicylic acid (SA) gel for a period of four weeks did not improve his HH. On November 3rd 2003, he was injected with Botulinum Toxin Type A (BTX-A, Botox® Allergan Pharmaceuticals, Irvine, California) at a dose of 200 mouse units (mu) per sole. Anesthesia was achieved through the nerve block technique. The patient had difficulty walking for several hours after this technique. Because the plantar HH did not improve a month after the injections, instead of resorting at still higher doses, topical 55 percent AC in 6 percent SA gel was resumed and the plantar HH and BH were brought under control within days. The initial application was nightly, reduced later to once a week or less.

Case 2—an 18 year-old woman was first seen on November 15, 2005 because of her recalcitrant plantar HH. Topical application of 55 percent AC in 6 percent SA gel for a period of 4 weeks failed to provide improvement. On January 16, 2007, the patient was treated with 150 mu of BTX-A per sole on both feet. Needle-free anesthesia was used as the analgesic method [1, 2, 3]. Because BTX-A injections proved to be inadequate to control plantar HH a month after their administration, 55 percent AC in 6 percent SA gel was resumed and within days HH became under control. The gel application was initially once daily, and was later tapered down to once every 7-10 days.
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Elizabeth Walsh · Oct 17, 2008

Sorry, I don't care what anyone thinks.

To me,

Botox = Boo!!

Admin2 · Sep 22, 2016

Here is the technique:

NewsBot · May 11, 2010

Effects of botulinum toxin-a therapy for palmar hyperhidrosis in plantar sweat production.
Gregoriou S, Rigopoulos D, Makris M, Liakou A, Agiosofitou E, Stefanaki C, Kontochristopoulos G.
Dermatol Surg. 2010 Apr;36(4):496-8.

BACKGROUND: Patients with focal hyperhidrosis in multiple areas often report improvement of plantar hyperhidrosis after botulinum toxin A (BTX-A) therapy for palmar hyperhidrosis.

OBJECTIVE: To assess sweat production from the soles in patients receiving BTX-A treatment for their palmar hyperhidrosis.

PATIENTS AND METHODS: Thirty-six patients with both palmar and plantar hyperhidrosis received 100 U of BTX-A per palm. Sweat production of palms and soles was assessed using a starch iodine test and gravimetry at baseline and 1, 3, and 8 months after treatment. Patients were subjectively assessed using a percentile scale.

RESULTS: All patients had significant improvement in their palmar hyperhidrosis that lasted for 6.2 +/- 1.8 months. Gravimetry revealed marginal improvement of plantar hyperhidrosis in 12 patients (from 39.7 +/- 21.3 to 31.5 +/- 18.0 mg/min; p=.01) and statistically significant worsening in 24 patients (from 71.6 +/- 70.60 to 109.94 +/- 82.93 mg/min, p<.001).

CONCLUSION: Treatment of palmar hyperhidrosis with BTX-A increased plantar sweating in many patients affected by both palmar and plantar hyperhidrosis in the population under study. Regardless, patients reported satisfaction with the results and were willing to repeat treatment.
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Elizabeth Walsh · May 15, 2010

I refer you to http://en.wikipedia.org/wiki/Botulinum_toxin and the discussion at http://en.wikipedia.org/wiki/Talk:Botulinum_toxin. There is an extensive list of references.

NewsBot · Aug 31, 2011

From Podiatry Today:
Can Botulinum Toxin Have An Effect For Hyperhidrosis?

NewsBot · Aug 29, 2013

This clinical trial was just regsitered:

Botulinum Toxin Treatment in Craniofacial, Inguinal, Palmar, Plantar and Truncal Hyperhidrosis

Hyperhidrosis is defined as excessive sweating and affects about 2.8 % of the population.

It has been shown to have a deleterious effect on the quality of life measured using the Dermatology Life Quality Index (DLQI) which is one of the most widely used dermatology-specific quality of life instruments. This is comparable to the effect on quality of life in patients with severe psoriasis of the skin as well as to nodulocystic acne patients before treatment with oral isotretinoin.

The clinical effect of Botulinum Toxin (Btx) A has been established in three randomized controlled trials (RCT) in axillary hyperhidrosis. One RCT has indicated a positive effect in palmar hyperhidrosis. Although there is increasing evidence that Btx A and B have a similar effect on hyperhidrosis of other parts of the body (ie hyperhidrosis of the face, trunk, groin and feet) which is reported in case-reports and open studies there is still a great need for more controlled studies. This is why we will carry out this randomized, double-blind, placebo-controlled study to investigate the clinical effect and safety of Btx A in palmar, plantar and inguinal (groins/buttocks) hyperhidrosis and the clinical effect and safety of Btx B in craniofacial and truncal hyperhidrosis, respectively. Besides using the DLQI instrument we will also study Btx A/B to elucidate the impact of this treatment on quality of life using a generic instrument, the effect on anxiety and depressive symptoms, sweating, and patients´global assessment of therapy.
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NewsBot · Sep 7, 2013

OnabotulinumtoxinA therapy for compensatory hyperhidrosis
Jessica A Adefusika, Jerry D Brewer
Journal of Cosmetic Dermatology; Volume 12, Issue 3, pages 232–234, September 2013

Background
Compensatory hyperhidrosis due to the treatment for focal primary hyperhidrosis can be devastating and life-altering.
Objective
The purpose of this paper is to discuss use of the iodine starch test and dilute botulinum toxin to decrease compensatory hyperhidrosis over large surface areas.
Methods
A large area of the trunk affected by compensatory hyperhidrosis was treated with dilute botulinum toxin therapy using a starch iodine test for localization.
Results
The patient had exceptional results with his compensatory truncal sweating returning to normal and remaining stable for multiple months.
Conclusion
Treating compensatory hyperhidrosis of large surface areas with dilute botulinum toxin therapy is effective and safe.
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NewsBot · Oct 26, 2013

Efficacy of Onabotulinum Toxin A (Botox) versus Abobotulinum Toxin A (Dysport) Using a Conversion Factor (1 : 2.5) in Treatment of Primary Palmar Hyperhidrosis
Hanan Mohamed El Kahky, Heba Mahmoud Diab, Dalia Gamal Aly, and Nehal Magdi Farag
Dermatology Research and Practice Volume 2013 (2013), Article ID 686329, 6 pages

Background. Two preparations of botulinum A toxin (BTX-A) are commercially available for the treatment of palmar hyperhidrosis (PPH): Botox (Allergan; 100 U/vial) and Dysport (Ipsen Limited; 500 U/vial), which are not bioequivalent. Results regarding an appropriate conversion factor between them are controversial. Objectives. This paper aims to compare the efficacy of Botox and Dysport in PPH using a conversion factor of 1 : 2.5.

Methods. Eight patients with severe PPH received intradermal injections of Botox in one palm and Dysport in the other in the same session. Clinical assessment was performed at baseline and posttreatment for 8 months using Minor’s iodine starch test, Hyperhidrosis Disease Severity Scale (HDSS), and Dermatology Life Quality Index (DLQI) test.

Results. At 3 weeks, a significant decrease in sweating for both preparations was noted which was more pronounced with Dysport compared with Botox. At 8 weeks, this difference turned insignificant. Continued evaluation showed similar improvement in both palms with a nonsignificant difference. Patients with longer disease duration were more liable to relapse.

Conclusion. The efficacy and safety of Botox and Dysport injections were similar using a conversion factor of 1 : 2.5. There was a trend towards a more rapid action after Dysport treatment but without significant importance.
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NewsBot · Dec 27, 2014

Safety and prolonged efficacy of Botulin Toxin A in primary hyperhidrosis.
D'Epiro S et al
Clin Ter. 2014 Nov-Dec;165(6):e395-400. doi: 10.7417/CT.2014.1780.

BACKGROUND:
Hyperhidrosis is a condition characterized by generalized or localized hyperfunction of the eccrine sweat glands with a deep negative impact on patient's quality of life.
OBJECTIVES:
To evaluate the efficacy and the safety of Botulin Toxin A (BTX-A) intradermal injection in the treatment of primary axillary and palmar hyperhidrosis, investigating symptoms-free period, and the subjective improving of quality life.
MATERIALS AND METHODS:
50 consecutive patients with primary hyperhidrosis were evaluated detecting age, gender, hyperhidrosis onset period, disease duration and years of treatment with BTX-A, Minor's iodine test, Hyperhidrosis Disease Severity Scale (HDSS), Dermatology Life Quality Index (DLQI).
RESULTS:
The treatment is significantly effective both for axillae and palms: the majority of the patients improved their HDSS and Minor's scores from a value of 4 in the two tests, to values of 1 (HDSS) and 0 (Minor test). Patients reported a duration of symptoms relief from 4 to 12 months, with a mean of 5.68 months; specifically, we have observed that the axillary group experienced a longer symptoms-free period (mean RFS 7.2 months) than the palmar group (mean: RFS 4.27 months).
CONCLUSIONS:
Authors suggest that BTX-A is a safe, easy, and fast procedure for the treatment of primary axillary and palmar hyperhidrosis.
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NewsBot · Feb 7, 2015

Botulinum toxin therapy for hyperhidrosis: reduction of injection site pain by nitrous oxide/oxygen mixtures
Lejla Paracka, Katja Kollewe, Reinhard Dengler, Dirk Dressler
Journal of Neural Transmission; February 2015

Injection site pain (ISP) reduces compliance of botulinum toxin (BT) therapy considerably. We wanted to study whether nitrous oxide/oxygen (NOO, Livopan®, Linde Gas Therapeutics, Unterschleißheim, Germany) can reduce ISP in patients receiving intracutaneous BT injections for axillary or palmar hyperhidrosis (HH). The study followed an open-label design comparing intraindividually ISP in both axillae and/or both palms when NOO was applied or not during BT injections. BT efficacy was measured by the Hyperhidrosis Disease Severity Scale (HDSS) and by a 4-point Self-Assessment Scale. ISP was documented by a Visual Analogue Scale (VAS) and the Verbal Scale of Pain Intensity (VSPI), adverse effects by a Structuralised Interview (SI). Altogether 13 patients (age 34.1 ± 12.4 years, 9 females, 4 males) were studied. 11 BT treatments were for biaxillary and 3 for bipalmar HH. BT reduced biaxillary HH from HDSS 3.7 ± 0.5 to 1.0 ± 0 and bipalmar HH from 3.6 ± 0.6 to 1.0 ± 0. All patients reported ISP reduction by NOO. In axillary HH, NOO reduced ISP from 55.7 ± 12.7 to 12.8 ± 7.5 on the VAS (p < 0.05) and from 4.1 ± 0.3 to 0.7 ± 0.5 on the VSPI (p < 0.05), in bipalmar HH from 60.0 ± 10.0 to 13.3 ± 5.8 on the VAS (p < 0.05) and from 5.0 ± 0 to 1.3 ± 0.5 on the VSPI (p < 0.05). Adverse effects were not identified. NOO is a potent, non-sedative, quickly reversible and safe inhalative analgesic which reduces ISP considerably in patients receiving BT therapy for axillary and palmar HH thus substantially improving compliance of BT therapy.
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NewsBot · Sep 9, 2018

Sweaty feet in adolescents—Early use of botulinum type A toxin in juvenile plantar hyperhidrosis
Matthias K. Bernhard MD Matthias Krause MD, PD Steffen Syrbe MD
Paed Derm: 04 September 2018

Background/Objectives
Plantar hyperhidrosis can have severe social effects on children and adolescents. Therapeutic options include antiperspirants and surgical interventions (eg, sympathectomy). Botulinum type A toxin is approved for axillary hyperhidrosis in adults only. The aim of the study was the determination of effect and safety of botulinum type A toxin in plantar hyperhidrosis in juvenile patients.

Methods
Children and adolescents with idiopathic focal plantar hyperhidrosis were treated with 50‐100 U of botulinum type A toxin per sole. Local anesthesia was provided using topical eutectic mixture of local anesthetics cream and ice, in combination with midazolam as an anxiolytic.

Results
Fifteen patients (aged 12‐17) were included in the study. Best results were achieved with a dose of 75‐100 U of botulinum type A toxin per sole. Two patients did not benefit from the therapy, and 11 (73%) were satisfied with the results. Nine patients (60%) experienced pain at the injection site for a maximum duration of 3 days. One patient reported transient focal weakness for 4 weeks.

Conclusion
Botulinum type A toxin seems to be a safe secondary treatment option for plantar hyperhidrosis in adolescents aged 12 and older. A dose of 75‐100 U per sole resulted in a good therapeutic effect of variable duration in most patients. There were no severe side effects.
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NewsBot · Nov 10, 2018

Sweaty feet in adolescents-Early use of botulinum type A toxin in juvenile plantar hyperhidrosis.
Bernhard MK et al
Pediatr Dermatol. 2018 Nov;35(6):784-786

BACKGROUND/OBJECTIVES:
Plantar hyperhidrosis can have severe social effects on children and adolescents. Therapeutic options include antiperspirants and surgical interventions (eg, sympathectomy). Botulinum type A toxin is approved for axillary hyperhidrosis in adults only. The aim of the study was the determination of effect and safety of botulinum type A toxin in plantar hyperhidrosis in juvenile patients.

METHODS:
Children and adolescents with idiopathic focal plantar hyperhidrosis were treated with 50-100 U of botulinum type A toxin per sole. Local anesthesia was provided using topical eutectic mixture of local anesthetics cream and ice, in combination with midazolam as an anxiolytic.

RESULTS:
Fifteen patients (aged 12-17) were included in the study. Best results were achieved with a dose of 75-100 U of botulinum type A toxin per sole. Two patients did not benefit from the therapy, and 11 (73%) were satisfied with the results. Nine patients (60%) experienced pain at the injection site for a maximum duration of 3 days. One patient reported transient focal weakness for 4 weeks.

CONCLUSION:
Botulinum type A toxin seems to be a safe secondary treatment option for plantar hyperhidrosis in adolescents aged 12 and older. A dose of 75-100 U per sole resulted in a good therapeutic effect of variable duration in most patients. There were no severe side effects.
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NewsBot · Oct 17, 2019

Development of botulinum toxin A-coated microneedle for treating palmar hyperhidrosis.
Shim DH, Nguyen TT, Park PG, Kim MJ, Park BW, Jeong HR, Kim DS, Joo HW, Choi SO, Park JH, Lee JM.
Mol Pharm. 2019 Oct 15.

Hyperhidrosis is a disorder that produces excess amount of sweat. The botulinum neurotoxin A (BoNT/A) has been used to treat hyperhidrosis through multiple intradermal injections at the site of condition. However, due to its toxicity, it is important to precisely deliver the proper dose of toxin to the target site. In addition, the use of conventional hyperdermic needle for multiple injections in the palm makes the approach undesirable and painful. Here, we designed a BoNT/A-coated microneedle (BoNT-MN) array and tested its efficacy as a substitute pain-free method to treat hyperhidrosis. BoNT-MNs were prepared by coating BoNT/A formulation on poly-lactic acid microneedles and were found to successfully penetrate in vitro thick skin. The coating formulations were then tested for its stability at 4°C, 25°C, and 37°C for 24 h. BoNT-MNs were found to be much more stable than its liquid state. Additionally, we carried out in vivo experiments by treating the right paw of mice with BoNT-MNs and found that the treatment induced a significant reduction of sweating response in the mouse's foot pads. Thus, BoNT/A treatment with microneedles is beneficial and may be used as a more efficient and less painful approach to treat hyperhidrosis.
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NewsBot · Apr 16, 2022

Ancillary Techniques to Relieve the Pain Associated With Botulinum Injections for Palmar and Plantar Hyperhidrosis

NewsBot · Feb 16, 2023

Botulinum toxin in the treatment of residual limb hyperhidrosis: A systematic reviewToxina botulínica para el tratamiento de la hiperhidrosis del miembro residual: revisión sistemática
J. Rocha Melo et al
Rehabilitación; Volume 57, Issue 3, July–September 2023, 100754

The aim of the study was to analyze the current evidence regarding the effect of intradermal injections of botulinum toxin on residual limb hyperhidrosis. A comprehensive search of the MEDLINE and Scopus databases from inception until December 2021 was performed according to the PRISMA guidelines. The search terms used were “botulinum toxins”, “botulinum toxins, Type A”, “rimabotulinumtoxinB”, “amputees”, “amputation stumps”, “amputation” and “residual limbs”. The specific controlled vocabulary of each database was also used (e.g., MeSH). One hundred and thirty-one different studies met this search criteria and were reviewed. Two independent reviewers assessed the quality of the manuscripts. Eight studies met the inclusion criteria for this review. The results demonstrated an improvement in residual limb hyperhidrosis in all studies. Botulinum toxin A or B can be regarded as safe and effective for the treatment of residual limb hyperhidrosis, as well as improving prosthesis use and quality of life.
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NewsBot · Apr 25, 2024 at 4:08 AM

Botulinum Toxin A and B for Palmoplantar Hyperhidrosis
Trond Eilertsen, Bjørn Øivind Kvammen & Øystein Grimstad
Dermatology and Therapy

Introduction
Hyperhidrosis is characterized by unpredictable, uncontrollable and excessive sweating. It occurs at rest and is not related to temperature. Hyperhidrosis is a common disorder that has a negative impact on quality of life (QoL). The aim of this quality assurance study was to investigate how treatment of palmoplantar hyperhidrosis with botulinum toxin A (BTX-A) and botulinum toxin B (BTX-B) led to improvement of patient reported outcome measures related to QoL.

Methods
A total of 35 patients with palmar and/or plantar hyperhidrosis who had received BTX-A (Dysport®) and BTX-B (NeuroBloc®) for palmar hyperhidrosis and BTX-B for plantar hyperhidrosis were included in this study. In total, palms were injected with a median dose (low to high) of 400 (100–550) units BTX-A and a median dose (low to high) of 200 (200–500) units. BTX-B was used in the thenar and hypothenar areas to avoid muscle weakness. In the soles a total median dose (low to high) of 600 (475–1000) units BTX-B was injected.

Results
At follow-up 2 weeks post-treatment, patients’ Dermatology Life Quality Index (DLQI) score improved from 13 to 2 (p < 0.001).

Conclusion
We found that BTX-A and BTX-B treatment for palmar hyperhidrosis and BTX-B treatment for plantar hyperhidrosis led to a substantial improvement of QoL.
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