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Effective Treatment With Intracutaneous Botulinum Toxin

Markus Naumann, MD; Uta Hofmann, MD; Ilka Bergmann, MD; Henning Hamm, MD; Klaus V. Toyka, MD; Karlheinz Reiners, MD

Arch Dermatol. 1998;134:301-304.

Objective  To evaluate the effect of intracutaneous injections of botulinum toxin type A on excessive focal hyperhidrosis.

Design  Therapeutic before-and-after trial over 4 months.

Setting  Neurological and dermatological university departments.

Patients  Eleven patients with excessive axillary, palmar, or plantar hyperhidrosis fulfilling the following criteria: (1) local and systemic drug therapy had failed to improve their symptoms; (2) the patients were severely disabled with respect to their occupation and social activities; and (3) a successful treatment by botulinum toxin would obviate the need for destructive surgical procedures.

Interventions  Three mouse units of botulinum toxin (Botox) per 4-cm² skin area was injected intracutaneously in 16 axillae, 8 palms, and 2 soles.

Main Outcome Measures  Reduction of hyperhidrosis as documented by the Minor iodine-starch test and gravimetrical assessment of local spontaneous sweat production measured over 1 minute.

Results  In all patients, botulinum toxin completely abolished sweating in the injected areas (P<.001) within 3 to 7 days. No relevant adverse effects occurred and no clinical recurrence of hyperhidrosis was observed within the follow-up period of up to 5 months. Occasionally, subclinical reactivation of sweat gland function was observed 4 months after treatment.

Conclusions  Intracutaneous botulinum toxin seems preferable to any hitherto used conservative or surgical procedures and may become the therapy of choice in pathological focal hyperhidrosis.

From the Departments of Neurology (Drs Naumann, Toyka, and Reiners) and Dermatology (Drs Hofmann, Bergmann, and Hamm), Bayerische Julius-Maximilians-Universität, Würzburg, Germany.

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