Treatment of plantar hyperhidrosis with botulinum toxin type A

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Abstract
Hyperhidrosis (excessive, uncontrollable sweating) can be embarrassing and disabling, significantly impacting social and professional performance and quality of life. Treatments aim to reduce sweating, but few are effective, often carrying the risk of significant side-effects. The aims of this study were to evaluate the efficacy and safety of botulinum toxin type A (BTX-A) for plantar hyperhidrosis and to investigate the role of the Dermojet as a potential injection technique. Ten adult patients (five men, five women), aged 19-51 years, with severe, previously unresponsive, plantar hyperhidrosis, were recruited to this single-center, open-label, noncomparative study. The hyperhidrotic area of each foot was injected over 15-20 sites without analgesia with 50 U BTX-A + 5 mL sterile saline using a Dermojet. Patients were followed up for 8 months with monthly sweat reduction assessments using Minor's iodine-starch test. Patients provided a treatment self-assessment after completion of follow-up. Within 7 days post-treatment, eight patients reported significantly decreased sweating, and seven patients were symptom free for up to 5 months. Patient self-assessment showed that seven of the 10 patients were satisfied with their treatment. One minor adverse event was reported comprising a temporary localized hematoma (one patient). Intracutaneous BTX-A injection using the Dermojet offers a simple, safe, and effective alternative for treatment of plantar hyperhidrosis.