Long-Term Safety and Efficacy of Botulinum Toxin A Treatment in Adolescent Patients with Axillary Bromhidrosis

Using Neuromodulators for Salivary, Eccrine, and Apocrine Gland Disorders

BACKGROUND

Sialorrhea, hyperhidrosis, bromhidrosis, and chromhidrosis are common glandular disorders that substantially impact patients' health and quality of life. Botulinum toxin can safely and temporarily decrease gland secretions by targeting the parasympathetic cholinergic neurons, resulting in diminished saliva and sweat production.

OBJECTIVE

The objective of this article is to describe the applications of neuromodulators for the treatment of salivary, eccrine, and apocrine glands.

METHODS

PubMed was searched from inception to February 1, 2024 using search terms "neurotoxin," "botulinum toxin," "sialorrhea," "hyperhidrosis," "bromhidrosis," and "chromhidrosis."

RESULTS

Incobotulinumtoxin A and Rimabotulinumtoxin B are approved by the FDA for the treatment of sialorrhea. Onabotulinumtoxin A is the only FDA-approved botulinum toxin for axillary hyperhidrosis and is used off-label for hyperhidrosis of nonaxillary sites, bromhidrosis, and chromhidrosis. Compared to botulinum toxin serotype A, serotype B has been associated with more immunogenicity, which may have implications for patients requiring long-term treatment for chronic glandular disorders.

CONCLUSION

Neuromodulators are safe and effective for the noninvasive treatment of excess gland activity and can improve patients' quality of life. While substantial literature supports botulinum toxin treatments for hyperhidrosis, further studies are needed to characterize standard dosing and administration techniques for sialorrhea, bromhidrosis, and chromhidrosis.

Effect of optimizing the use of endoscope on the efficiency of microdynamic bromhidrosis removal operation

BACKGROUND

Bromhidrosis, also known as body odor, is a common disease in life, which often occurs in young adults. The histological basis of bromhidrosis is the hyperplasia of apocrine sweat glands.

OBJECTIVE

To compare the effects of different methods of endoscopy in microdynamic axillary osmidrosis removal on curative effect, complications, and surgical efficiency.

METHODS

A total of 149 patients with axillary osmidrosis were treated in our hospital from January 2020 to December 2021. They were treated with endoscopic assistance in the whole process of operation (Group A) and endoscope-assisted exploration after blind rotary cutter suction (Group B), respectively, and the curative effect, complication rate, and surgical efficiency were evaluated.

RESULTS

There was no significant difference in the curative effect and complication rate between the two groups, but the endoscope-assisted exploration group after suction with rotary cutter (Group B) had higher surgical efficiency.

CONCLUSION

On the basis of professional use of rotary cutter, it is efficient to choose endoscope to check the excision of sweat gland in the operation area and stop bleeding in time after blind suction.

Botulinum Toxins and Zinc: From Theory to Practice-A Systematic Review

OBJECTIVE

The aims of this study were to determine whether zinc supplementation affects botulinum toxin's effect and longevity and to establish a transition from the molecular to the clinical aspect.

METHODS

We conducted a systematic review in which we included all published studies on PubMed and Embase using the combination of the following terms: "zinc" AND (botox OR botulinum OR onabotulinumtoxinA OR abobotulinumtoxinA OR incobotulinumtoxinA).

RESULTS

From the 260 yielded articles, 3 randomized control trials and 1 case report were retained. Three of them found a significant improvement with zinc supplementation in the toxin's effect and longevity. This was observed in neurological conditions and cosmetic uses.

CONCLUSIONS

Zinc supplementation could be an interesting asset in the potentialization of botulinum neurotoxin effect and longevity. Larger clinical trials and objective measurement tools should be used to further defining the role of zinc in maximizing botulinum neurotoxin effect.

Clinical analysis of tumescent anesthesia technique combined with superficial fascia rotational atherectomy in axillary bromhidrosis

Axillary bromhidrosis, which involves the apocrine sweat glands, severely affects adolescents. The present study aimed to evaluate the effect of tumescent anesthesia technique combined with superficial fascia rotational atherectomy treatment for axillary bromhidrosis. The present retrospective study included a total of 60 patients with axillary bromhidrosis. These patients were divided into experimental and control groups. Patients in the control group were treated using the tumescent anesthesia technique combined with conventional surgery, while patients in the experimental group were treated using the anesthesia technique combined with superficial fascia rotational atherectomy. The intraoperative blood loss, operation time, histopathological examination and dermatology life quality index (DLQI) score were used to assess the treatment effect. The intraoperative blood loss and operation time were significantly lower in the experimental group compared with the control group. The histopathological results revealed that the sweat gland tissues in experiment group significantly decreased compared with that in control group. Furthermore, there was a significant improvement in axillary odor degree for postoperative patients, and the DLQI scores in experiment group were significantly lower compared with those in control group. The tumescent anesthesia technique combined with superficial fascia rotational atherectomy is a promising approach to treating patients with axillary bromhidrosis.

Impact of Apocrine Gland Residue on Bromhidrosis Clinical Efficacy: A Self-controlled Case Series Study

Apocrine sweat gland excision is a successful surgical treatment for bromhidrosis used in clinical practice due to its efficacy and unobtrusive postoperative scar. However, a small quantity of apocrine sweat gland residue is an unavoidable intraoperative concern to minimize losses of the dermal vascular network induced by extensive excision of the apocrine sweat glands. However, the relationship between the degree of remaining glands and clinical efficacy is yet unknown. This study looked at the histopathology of preexcision and postexcision specimens from bromhidrosis patients to see a connection between residual apocrine sweat glands and clinical efficacy following apocrine sweat gland excision.

Utilities of Botulinum Toxins in Dermatology and Cosmetology

Botulinum toxin (BoNT) is a neurotoxin produced by the Clostridium botulinum bacterium with a well-known efficacy and safety profile in the focal idiopathic hyperhidrosis treatment. BoNT comprises seven different neurotoxins; however, only toxins A and B are clinically employed. BoNT is lately practiced in off-label therapies for a variety of skin diseases. Scar prevention, hyperhidrosis, rhytides, eccrine nevus, alopecia, psoriasis, Darier disease, bullous skin disease, pompholyx and Raynaud's phenomenon are some of the novel indications for BoNT in cosmetic and notably non-cosmetic aspects of dermatology. To employ BoNT correctly in clinical practice, we must have a thorough understanding of the functional anatomy of the mimetic muscles. An intensive literature search was conducted to update all dermatology-oriented experiments and clinical trials on the described element of BoNT for this general overview of BoNT use in dermatology. This review aims to analyse the role of BoNT in dermatology and cosmetology.

Treatment of axillary bromhidrosis in adolescents by combining electrocauterization with ultrasound-guided botulinum toxin type A injection

The aim of this study is to investigate the efficacy of treatment-combined electrocauterization after removal of apocrine sweat glands with ultrasound-guided (BOTOX) injection for adolescents with axillary bromhidrosis. From January 2015 to January 2018, 90 adolescents with axillary bromhidrosis were recruited and randomly divided into three groups (group A, B, and C). Patients in group A underwent electrocauterization after removal of apocrine sweat glands, patients in group B received ultrasound-guided BOTOX injection, and patients in group C had electrocauterization after the removal of apocrine sweat glands followed by ultrasound-guided BOTOX administration after two weeks. All patients were followed up for one year. The percentages of axillary malodor score at twelve months after treatments compared with pre-operation for group A, group B, and group C were 20.2%, 27.5%, and 12.5%, respectively. Significant statistical differences were observed in changes of axillary malodor score among the three groups at three, six, nine and twelve months postoperatively. Satisfaction rates of group A, group B, and group C were 90.0%, 93.3%, and 96.7%, respectively. The side effects after surgery in group A were similar to group C, and no side effect was observed in group B. One-year postoperative scar formation rate of group A was 16.7%, which was significantly higher than that of group B (0) and group C (6.66%). Combination of electrocauterization after removal of apocrine sweat glands with ultrasound-guided BOTOX injection showed better treatment effects.

Therapeutic Use of Botulinum Neurotoxins in Dermatology: Systematic Review

Botulinum toxin is a superfamily of neurotoxins produced by the bacterium Clostridium Botulinum with well-established efficacy and safety profile in focal idiopathic hyperhidrosis. Recently, botulinum toxins have also been used in many other skin diseases, in off label regimen. The objective of this manuscript is to review and analyze the main therapeutic applications of botulinum toxins in skin diseases. A systematic review of the published data was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Botulinum toxins present several label and off-label indications of interest for dermatologists. The best-reported evidence concerns focal idiopathic hyperhidrosis, Raynaud phenomenon, suppurative hidradenitis, Hailey–Hailey disease, epidermolysis bullosa simplex Weber–Cockayne type, Darier’s disease, pachyonychia congenita, aquagenic keratoderma, alopecia, psoriasis, notalgia paresthetica, facial erythema and flushing, and oily skin. Further clinical trials are still needed to better understand the real efficacy and safety of these applications and to standardize injection and doses protocols for off label applications.

Alternative Clinical Indications of Botulinum Toxin

Botulinum toxin type A (BoNTA) is a powerful neurotoxin that inhibits acetylcholine release from presynaptic vesicles. The potency and safety profile of BoNTA grant the toxin vast therapeutic potential. It has been used off-label for a variety of dermatologic conditions. This review aims to analyze published literature regarding the benefits and risks of the off-label use of BoNTA beyond facial lines, including eccrine hidrocystomas, enlarged pores, keloids and hypertrophic scars, hidradenitis suppurativa, hyperhidrosis, masseter muscle hypertrophy, and salivary gland hypertrophy, among others. A MEDLINE search from January 2000 to December 2019 was conducted on the off-label uses of botulinum toxin in dermatology.

Botulinum Toxin Type B for Hidradenitis Suppurativa: A Randomised, Double-Blind, Placebo-Controlled Pilot Study

Background

Botulinum toxin (BTX) is a potent neurotoxin with a long history of therapeutic application in neurological and dermatological conditions, with a strong efficacy and safety profile.

Objective

Our aim was to assess whether intradermal injection with BTX-B is an effective treatment for hidradenitis suppurativa (HS).

Methods

Twenty patients with HS stage I–III disease, according to Hurley’s classification, were consecutively included for treatment with either a placebo or BTX-B. At the next intervention after 3 months, all participants received the active substance and another follow-up at 6 months. The primary outcome was quality of life, measured using the Dermatology Life Quality Index (DLQI), while secondary outcomes were the visual analogue scale (VAS) for pain in the worst boil and HS-related impairment of general health (VAS), as well as changes in physician-reported disease activity assessed as the number of total lesions, and reported adverse effects of treatment.

Results

The DLQI improved from a median of 17 at baseline to 8 at 3 months in the BTX-B group, compared with a reduction from 13.5 to 11 in the placebo group (p <0.05). Improvement of the patients’ own ratings of symptoms and a reduction in total lesions supplemented the primary outcome. Fifty-five percent of the study population reported some degree of hyperhidrosis.

Conclusion

BTX-B improves the quality of life in patients with HS. Furthermore, comorbidity between HS and hyperhidrosis is suggested.

Trial Registration

ClinicalTrials.gov identifier: NCT03103074.