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Year : 2022  |  Volume : 15  |  Issue : 5  |  Page : 815-816  

Hyperhidrosis, oromandibular dystonia, and botulinum toxin type a (Botox)

Department of Medicine, Federal University of Santa Maria, Rua Roraima, Santa Maria, Rio Grande do Sul, Brazil

Date of Submission31-Mar-2021
Date of Decision25-Mar-2022
Date of Acceptance27-Mar-2022
Date of Web Publication01-Jun-2022

Correspondence Address:
Dr. Jamir Pitton Rissardo
Rua Roraima, Santa Maria, Rio Grande do Sul
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_242_21

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How to cite this article:
Rissardo JP, Fornari Caprara AL. Hyperhidrosis, oromandibular dystonia, and botulinum toxin type a (Botox). Med J DY Patil Vidyapeeth 2022;15:815-6

How to cite this URL:
Rissardo JP, Fornari Caprara AL. Hyperhidrosis, oromandibular dystonia, and botulinum toxin type a (Botox). Med J DY Patil Vidyapeeth [serial online] 2022 [cited 2022 Dec 10];15:815-6. Available from: https://www.mjdrdypv.org/text.asp?2022/15/5/0/346448

Dear Editor,

We recently wrote a letter about botulinum toxin (Botox) and spasticity entitled ''Multiple solitary plasmacytoma, spasticity, and botulinum toxin'' in the esteemed ''Medical Journal of Dr. D.Y. Patil Vidyapeeth,'' where we described the importance of a new treatment approved for lower limb spasticity in children.[1] Now, we would like to describe the importance of botox on another neurological condition.

Hyperhidrosis is characterized by excessive sweating due to the over-stimulation of cholinergic receptors on eccrine glands, in which the acetylcholine negative feedback loop is probably impaired. The prevalence in the United States is about 3%, and can significantly impair the quality of life of the affected individuals. The management of this disorder is based initially on topical aluminum chloride and oral anticholinergic medications. Sympathectomy and botox are reserved for severe and resistant cases.[2]

Herein, we would like to address some important topics from recently published articles about hyperhidrosis to achieve a better comprehension of the management of this disorder. [Figure 1] shows the management of hyperhidrosis.[1],[2],[3]
Figure 1: Hyperhidrosis management. Topical agents: Aluminum chloride, glycopyrronium tosylate, tannic acid, potassium permanganate. Oral anticholinergics: Oxybutynin. Iontophoresis is a long-term treatment and at best, its effects are mild. Many agents can be added to the water but compliance with this treatment is low

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Gibbons et al.[3] studied the quality of life and cost-effectiveness of endoscopic sympathectomy and botox. More than 40 patients were assessed, and the results showed that both therapies were successful and improved daily life activities. Also, the cost for botox was approximately €389 every 5.6 months, and for the endoscopic thoracic sympathectomy, €9389. Therefore, they concluded that due to the similar efficacy and the cost equivalence of 13.3 years between these two options, the botulinum toxin alone should be considered the gold standard for the treatment of axillary hyperhidrosis.

Mostafa et al.[4] evaluated the primary palmar hyperhidrosis based on the dermatology life quality index and the hyperhidrosis disease severity scale in eight patients that were randomly assigned for botox or sympathectomy by C-arm guided percutaneous radiofrequency. Both scales and even the number of repeated procedures were lower in the sympathectomy group. Thus, the authors stated that percutaneous ablation is probably more effective and has better cost-effectiveness with greater patient satisfaction when compared to botox injections. Another recent Chinese study showed similar results in about 50 participants, but the thoracic sympathectomy had more percentage of complications.[5]

Karlsson-Groth et al.[6] studied the treatment of compensatory hyperhidrosis after sympathectomy, which when compared with the general literature had a lower percentage. They assessed the use of botox and anticholinergics in these compensatory individuals. More than 90% of the patients were satisfied after the use of botox; when there was residual sweating, the subject received anticholinergics and the outcomes were even better than botox alone. So, the combination of botox and anticholinergics should be considered in the compensatory group because it is usually safe, effective, and well-tolerated.

Panda and Pandey studied the uses of botulinum toxin in the management of patients with movement disorders in India. Their results showed that low uses of ultrasonography, difficulty in muscle localization, and cost of the toxin were important limitations to the use of botox.[7] Also, it is worth mentioning that the use of botox injections is not yet established, and the studies available are few, small, and non-controlled. However, botox may be the most effective treatment available and the most important medication to improve the quality of life in individuals with dystonia.[8]

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Conflicts of interest

There are no conflicts of interest.

  References Top

Rissardo JP, Fornari Caprara AL. Multiple solitary plasmacytoma, spasticity, and botulinum toxin. Med J DY Patil Vidyapeeth 2021;14:353-4.  Back to cited text no. 1
  [Full text]  
Brackenrich J, Fagg C. Hyperhidrosis. StatPearls: StatPearls Publishing; 2018.  Back to cited text no. 2
Gibbons JP, Nugent E, O'Donohoe N, Maher B, Egan B, Feeley M, et al. Experience with botulinum toxin therapy for axillary hyperhidrosis and comparison to modelled data for endoscopic thoracic sympathectomy-A quality of life and cost effectiveness analysis. Surgeon 2016;14:260-4.  Back to cited text no. 3
Mostafa TAH, Hamed AA, Mohammed BA, El Sheikh NA, Shama AAA. C-Arm guided percutaneous radiofrequency thoracic sympathectomy for treatment of primary palmar hyperhidrosis in comparison with local botulinum toxin type A injection, randomized trial. Pain Physician 2019;22:591-9.  Back to cited text no. 4
Yang HJ, Kang J, Zhang S, Peng K, Deng B, Cheng B. CT-Guided chemical thoracic sympathectomy versus botulinum toxin type A injection for palmar hyperhidrosis. Thorac Cardiovasc Surg 2019;67:402-6.  Back to cited text no. 5
Karlsson-Groth A, Rystedt A, Swartling C. Treatment of compensatory hyperhidrosis after sympathectomy with botulinum toxin and anticholinergics. Clin Auton Res 2015;25:161-7.  Back to cited text no. 6
Panda AK, Pandey S. Uses of botulinum toxin in the management of patients with movement disorders: A national survey from India. Ann Mov Disord 2020;3:39-43.  Back to cited text no. 7
  [Full text]  
Rissardo JP, Fornari Caprara AL. Oromandibular dystonia and botulinum neurotoxin: An overview. Med J DY Patil Vidyapeeth 2019;12:554-5.  Back to cited text no. 8


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