Botulinumtoxin bei fokaler Hyperhidrose

Injectable and topical neurotoxins in dermatology: Indications, adverse events, and controversies

The use of neuromodulators for therapeutic and cosmetic indications has proven to be remarkably safe. While aesthetic and functional adverse events are uncommon, each anatomic region has its own set of risks of which the physician and patient must be aware before treatment. The therapeutic usages of botulinum toxins now include multiple specialties and multiple indications. New aesthetic indications have also developed, and there has been an increased utilization of combination therapies to combat the effects of global aging. In the second article in this continuing medical education series, we review the prevention and treatment of adverse events, therapeutic and novel aesthetic indications, controversies, and a brief overview of combination therapies.

Repetitive injections of botulinum toxin A continuously increase the duration of efficacy in primary axillary hyperhidrosis: a retrospective analysis in 101 patients

BACKGROUND AND OBJECTIVES

Botulinum toxin type A is an effective, well-tolerated, albeit temporary treatment for primary axillary hyperhidrosis. However, little is known about the influence of repetitive injections on the duration of efficacy.

PATIENTS AND METHODS

139 patients with primary axillary hyperhidrosis were injected with 50 units of botulinum toxin per axilla. In 101 patients, who received at least three treatments, the duration of efficacy after the first, second, and last treatment was evaluated.

RESULTS

The median duration of efficacy was 4.0 months, 4.5 months, and 5.0 months after the first, second, and last injection, respectively. Overall, the duration of efficacy was significantly longer after the last injection compared to the duration of efficacy after the first injection (p = 0.0055, Wilcoxon matched-pairs signed-rank test). Likewise, the difference between the first and second injection (p = 0.0302) as well as the difference between the second and the last injection (p = 0.0381) were significant. In 25.7 % of patients, the duration of efficacy remained unchanged over the entire treatment period.

CONCLUSIONS

Repetitive botulinum toxin treatments led to a significantly increased duration of efficacy in axillary hyperhidrosis. While the average duration of efficacy continued to increase with each treatment, there were considerable interindividual differences.

[Botulinum toxin in dermatology]

Treatment with botulinum toxin (BTX) type A has become increasingly important in various clinical areas in dermatology. Particularly popular is the therapy with BTX for hyperkinetic lines associated with muscles of facial expression in aesthetic dermatology, which is the most frequent wrinkle treatment undertaken worldwide. Therapy with BTX also ranks high in curative dermatology. Injections with BTX are the most effective nonoperative therapy for hyperhidrosis. Common indications for the treatment of hyperkinetic lines with BTX are presented in this publication. Therapy of glabellar lines, which has received regulatory approval, is presented in detail. In the second part, treatment of focal hyperhidrosis with emphasis on axillary hyperhidrosis is addressed. In the hand of the experienced practitioner, treatment with BTX in a suitable area of indication is a very safe and effective procedure that leads to remarkable treatment results, associated with a very high patient satisfaction.

Duration of efficacy increases with the repetition of botulinum toxin A injections in primary axillary hyperhidrosis: a study in 83 patients

BACKGROUND

Intradermal injections of botulinum toxin are effective but transitory in primary axillary hyperhidrosis. These injections are repeated when the symptoms recur. The reported duration of efficacy is variable, from 2 to 24 months, but it is unknown how the duration of efficacy changes when injections are repeated.

OBJECTIVE

In this retrospective study, we aimed to evaluate changes in the duration of efficacy of botulinum toxin injections (Dysport, Ipsen, Boulogne-Billancourt, France) with the repetition of injections in patients with axillary hyperhidrosis.

METHODS

From May 2001 to April 2012 inclusive, 83 patients were treated with a dose of 125 U per underarm. We compared the duration of effect of the first and last toxin injections.

RESULTS

The median duration of efficacy for the first injection was 5.5 months, whereas that for the last injection was 8.5 months. The difference between these 2 durations is statistically significant (P = .0002).

LIMITATIONS

Although retrospective and based on the declarative, this work is the first to our knowledge to highlight this benefit of treatment and to evaluate botulinum toxin over such a long period (11 years).

CONCLUSION

There appears to be an increase in the duration of efficacy of botulinum toxin A injections with the repetition of injections in patients with primary axillary hyperhidrosis. The reasons for this effect may be linked to the mechanism of action of botulinum toxin, and may improve our understanding of its pharmacologic effects.

Dermatological problems of the puberty

Puberty is a period of life between childhood and adulthood. It is characterized by many changes in morphology and appearance of the body (biological maturation), in the psyche - development of personality (psychological maturation), and in the attitude towards one's own and the opposite sex (psychosexual maturation), and in the social role (social maturation). Dermatological problems of adolescence are mainly related to fluctuations in hormone levels, mainly androgens. They include acne, hair problems and excessive sweating. Acne vulgaris is the most frequently diagnosed dermatosis in patients aged between 11 and 30 years. It is believed that it affects about 80% of persons in this age group or even, taking into account lesions of low intensity, 100% of young people. Excessive sweating is a condition characterised by excessive production of sweat, resulting from high activity of sweat glands. The sweat glands are localised in almost all areas of the body surface but on the hands, feet, armpits and around the groin they are found at the highest density. Seborrhoeic dermatitis of the scalp is a chronic, relapsing, inflammatory dermatosis, which currently affects about 5% of the population. It affects mostly young people, particularly men.