Botulinum toxin in the treatment of sweat-worsened foot problems in patients with epidermolysis bullosa simplex and pachyonychia congenita

Background: Hyperhidrosis is defined as excessive sweating which can be primary or secondary. Data about the prevalence of primary hyperhidrosis are scarce for northern Europe. Objective: Our aim was to investigate the prevalence of hyperhidrosis focusing on its primary form and describe the quality of life impairments for the affected individuals. Methods: Five thousand random individuals aged 18-60 years in Sweden were investigated. The individuals' addresses were obtained from Statens personadressregister, SPAR, which includes all persons who are registered as resident in Sweden. A validated questionnaire regarding hyperhidrosis including the Hyperhidrosis Disease Severity Scale (HDSS) and 36-item Short Form (SF-36) health survey was sent to each individual. The participants were asked to return the coded questionnaire within 1 week. Results: A total of 1,353 individuals (564 male, 747 female and 42 with unspecified gender) with a mean age of 43.1 ± 11.2 years responded. The prevalence of primary hyperhidrosis was 5.5%, and severe primary hyperhidrosis (HDSS 3-4 points) occurred in 1.4%. Secondary hyperhidrosis was observed in 14.8% of the participants. Our SF-36 results showed that secondary hyperhidrosis causes a significant (p < 0.001) impairment of both mental and physical abilities while primary hyperhidrosis impairs primarily the mental health (p < 0.001). Conclusion: Hyperhidrosis affects individuals in adolescence as a focal form while occurring as a generalised form with increasing age. Further, the prevalence of primary hyperhidrosis described in our study is comparable to other studies from the western hemisphere. While secondary, generalised hyperhidrosis impairs both physical and mental aspects of life, primary hyperhidrosis, with the exception of severe cases, mainly affects the mental health.

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“…Comorbidities such as pachyonychia congenita and epidermolysis bullosa simplex of the Weber-Cockayne type have also been described in PH [8,9] .…”

mentioning

confidence: 99%

Prevalence and Characteristics of Hyperhidrosis in Sweden: A Cross-Sectional Study in the General Population

Shayesteh

Janlert²,

Brulin

et al. 2016

Dermatology

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“…Botulinum toxin injections have also been advocated for pediatric disorders exacerbated by hyperhidrosis and for which topical application of aluminum chloride salts is poorly tolerated and/or minimally effective, such as dyshidrotic eczema, 17 pachyonychia congenita, and epidermolysis bullosa simplex. 18 In a 1-year, randomized, placebocontrolled trial of more than 200 adults treated with botulinum toxin A, axillary hyperhidrosis was markedly improved in 75% of patients by 1 month after intradermal injection, in contrast to similar improvement with 25% of placebo-treated patients; no serious adverse effects were noted. 19 Injections of botulinum toxin in a child were first described in 2002 for a 13-year-old with refractory palmar hyperhidrosis, 20 and injections for axillary hyperhidrosis were initially reported in 2005.…”

Section: Discussionmentioning

confidence: 99%

Oral glycopyrrolate as second-line treatment for primary pediatric hyperhidrosis

Paller

Shah

Silverio

et al. 2012

Journal of the American Academy of Dermatology

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“…One patient abandoned wheelchair use. The promising experience of Swartling and Vahlquist led the same authors to an interesting retrospective evaluation of the effects of BoNT-A injections in 14 patients with EBS and PC with foot blisters and painful callosities [47] . They observed analogues results in improvement of blisters and pain; the hypothesis that explains these effects was that BoNT-A can affects nociceptive C-fibers in the skin via inhibition of neuropeptide release from sensory nerve axons and also inhibits the neurogenic inflammation [48] .…”

Section: Pachyonychia Congenitamentioning

confidence: 99%

Botulinum Toxin Off-Label Use in Dermatology: A Review

Campanati

Martina

Giuliodori

et al. 2017

Skin Appendage Disord

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focal hyperhidrosis, aesthetic medicine and neurological conditions with a strong efficacy and safety profile [1][2][3][4][5][6][7] . The enormous therapeutic potential of this drug contributed to a number of broad applications, especially in dermatological diseases. A large number of these indications are still lacking shared, approved protocols for dilution, doses, and timing of follow-up and retreatment. Also the injection techniques are still debated, depending on the operator's experience, angle of injection and depth. We have previously published a novel injection approach consisting in a needle adaptor that ensures a uniform administration of the toxin [3] . The aim of this review was to collect and analyze the published data concerning the most relevant off-label indications of BoNT-A. MethodsA PubMed search from 1950 to July 2016 was performed to identify any reports on the use of botulinum toxin in off-label indications concerning dermatology. We detected these articles using the terms "botulinum toxin dermatology," "botulinum toxin treatment," "botulinum toxin off-label," and meshed with a secondary search of studies pertaining to each indication. Only studies in English were reviewed. All studies that met the criteria were included and summarized in this review. KeywordsBotulinum toxin · Off-label therapy · Keloids · Hidradenitis suppurativa · Folds dermatitis Abstract Background: Botulinum toxin is a neurotoxin produced by the bacterium Clostridium botulinum which causes a flaccid muscle paralysis. It is currently used for aesthetic treatments and in the focal hyperhidrosis. Recently, botulinum toxin has also been used experimentally in many other dermatological conditions with good results. Objective: To review and analyze the possible botulinum toxin off-label applications published. Methods: A retrospective review of the published data was conducted. Conclusions: this potent drug can lead to several off-label indications of interest for dermatologists. Further clinical trials are still needed to better understand the real efficacy and safety of these applications and to standardize injection and dose protocols.

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Botulinum toxin in the treatment of sweat-worsened foot problems in patients with epidermolysis bullosa simplex and pachyonychia congenita

Abstract: Plantar injection of Btx is an efficient, long-lasting and safe treatment of painful blistering and callosities in EBS and PC that can be given repeatedly without loss of efficacy.

Cited by 53 publications

References 23 publications

Prevalence and Characteristics of Hyperhidrosis in Sweden: A Cross-Sectional Study in the General Population

Prevalence and Characteristics of Hyperhidrosis in Sweden: A Cross-Sectional Study in the General Population

Oral glycopyrrolate as second-line treatment for primary pediatric hyperhidrosis

Botulinum Toxin Off-Label Use in Dermatology: A Review

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