Primary palmar hyperhidrosis treated with intradermal botulinum toxin type A injection and topical aluminum chloride
Keywords:
Palmar hyperhidrosis, Botulinum toxin hypersensitivity, Aluminium chlorideAbstract
Background: Primary focal hyperhidrosis is a chronic, idiopathic, excessive sweating beyond the amount necessary for normal thermoregulation. It can affect one or more areas of the body, commonly the face, armpits, palms, or feet. This can cause great disruption in the quality of life of the patients and need to be treated properly. Various treatment options are available, including topical and systemic drugs, botulinum toxin type A injection, iontophoresis, microwave thermolysis, and surgery. Effective hyperhidrosis treatment varies among patients and may involve combination therapy. Case report: We report a case of primary palmar hyperhidrosis in a 33-year-old man. The patient had been using topical 15% aluminum chloride for 1 month without significant improvement. We administered intradermal botulinum toxin A injections, 100 IU for each palm, which led to marked improvements but still was not satisfying. Topical 10.8% aluminum chloride was given. Hyperhidrosis disease severity scale (HDSS) improved from 4 (severe) to 1 (mild). Discussion: Topical aluminum chloride is one of the first-line therapy for hyperhidrosis considering its safety, cost-effectiveness, and efficacy profile. Botulinum toxin A injection can be used in cases of severe hyperhidrosis or refractory to topical treatment. Nevertheless, not all patients respond to monotherapy approach, thus combination therapy can be recommended. Conclusion: In this case report, combination of intradermal botulinum toxin A injection and topical 10.8% aluminum chloride was found to be effective in controlling hyperhidrosis in a patient with partial response to monotherapy of either agent.References
Nawrocki S, Cha J. The etiology, diagnosis and management of hyperhidrosis: a comprehensive review. Part I. Etiology and clinical work-up. J Am Acad Dermatol. 2019;81(3):657-66.
Gregoriou S, Sidiropoulou P, Kontochristopoulos G, Rigopoulos D. Management strategies of palmar hyperhidrosis: challenges and solutions. Clin Cosmet Investig Dermatol. 2019;12:733-44.
Stuart ME, Strite SA, Gillard KK. A systematic evidence-based review of treatments for primary hyperhidrosis. J Drug Assess. 2020;10(1):35-50.
Nawrocki S, Cha J. Botulinum toxin: pharmacology and injectable administration for the treatment of primary hyperhidrosis. J Am Acad Dermatol. 2020;82(4):969-79.
De Almeida AR, de Costa Marques ER. Botulinum toxin for palmar and plantar hyperhidrosis. In: da Costa, editor. Minimally Invasive Aesthetic Procedures: A Guide for Dermatologists and Plastic Surgeons. Switzerland: Springer Nature; 2020. p.229-33.
Benohanian A. Treatment of recalcitrant plantar hyperhidrosis with type-A botulinum toxin injections and aluminum chloride in salicylic acid gel. Dermatol Online J. 2008; 14(2):5.
Woolery-Lloyd H, Valins W. Aluminum chloride hexahydrate in a salicylic acid gel base: a case series of combination therapy with botulinum toxin type A for moderate to severe hyperhidrosis. Cutis. 2011;88(1):43-5.
