An enhanced transcutaneous delivery of botulinum toxin for the treatment of Hailey–Hailey disease

Abstract

Successful treatment of Hailey-Hailey disease with intradermal botulinum toxininjections has been previously reported. The main disadvantages of this treatment are the excruciating pain and the risk of infections due to the numerous injections.We sought to evaluate the clinical effectiveness and safety profile of a novel approach using an energy-based device (Tixel, Novoxel, and Israel), followed by the topical application of botulinum toxin Type A for the treatment of Hailey-Hailey disease. A retrospective study of all cases of histologically diagnosed cases of Hailey-Hailey disease treated with Tixel device followed by topical application of botulinum toxin between 2018 and 2019 was performed. Epidemiologic, clinical, and treatment data, including effectiveness score and safety, were reviewed. The study included eight patients, of whom seven patients (87.5%) showed good or partial response. No systemic or local adverse effects were reported. There was no difference in effectivity between different body areas. Response to treatment ranged between patients with an average duration of 7.125 months after the second treatment. Tixel treatment followed by topical application of botulinum toxin can be considered in the treatment of Hailey-Hailey disease. This approach is less invasive, less painful, and yet effective as well as safe.

Botulinum toxin in treating Hailey‐Hailey disease: A systematic review

“…14 In the following 20 years, this treatment gained necessary traction, with a total of 16 articles published including 38 patients. Only one case had no response, 17 while the other patients all had partial or complete remission, which demonstrated satisfactory therapeutic effects. However, only case reports and case series with small sample size were published on the 17,31 We also identified nine articles mainly describing other treatment options and only using botulin toxin previously.…”

“…Only one case had no response, 17 while the other patients all had partial or complete remission, which demonstrated satisfactory therapeutic effects. However, only case reports and case series with small sample size were published on the 17,31 We also identified nine articles mainly describing other treatment options and only using botulin toxin previously. In these nine articles including 10 patients, most patients had little response to botulinum toxin, but was successfully treated with other modalities.…”

“…43 Intradermal injection or intralesional injection of botulinum toxin was used in all the selected articles, except a recent one. 17 In 2020, Bar-Ilan and colleagues used an energy-based device, Tixel, to thermally decompose the stratum corneum, followed by topical application of botulinum toxin in treating patients with Hailey-Hailey disease. 17 In eight enrolled patients, seven showed good or partial responses, but one did not respond at all.…”

“…Sixteen articles described the use of botulinum toxin in treating patients with Hailey-Hailey disease, and the detailed description was shown in Table 1. 14,16,17,21,[23][24][25][26][27][28][29][30][31][32][33][34] The articles were published between 2000 and 2020. A total of 38 patients were included.…”

“…This treatment has also been applied and improved in recent years. 16,17 There were also some articles in which patients failed botulinum toxin treatment, but were successfully treated by other treatment options. [18][19][20] This study aimed to examine all published articles on botulinum toxin in the treatment of Hailey-Hailey disease, and to evaluate its efficacy and safety.…”