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Galadari H, Galadari I, Smit R, Prygova I, Redaelli A. Treatment approaches and outcomes associated with the use of abobotulinumtoxinA for the treatment of hyperhidrosis: A systematic review. J Am Acad Dermatol 2021; 85:1121-1129. [DOI: 10.1016/j.jaad.2020.07.123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/20/2020] [Accepted: 07/30/2020] [Indexed: 11/30/2022]
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Abstract
INTRODUCTION Hyperhidrosis affects 4.8% of the U.S. population and has been underestimated by physicians for long time despite considerable interference with quality of life. Many patients suffer from primary (idiopathic) hyperhidrosis which results from over-activity of sympathetic nerves and is restricted to specific body areas, mostly the axillae, palms, soles, or head. Secondary hyperhidrosis is caused by an underlying disease or the intake of medications and often involves large parts of the body. Numerous effective therapies with topical or systemic drugs and surgical options are available. Areas covered: Efficacy and safety data on aluminum salts, anticholinergic drugs for topical or systemic application, and on intradermal botulinum toxin injections used to treat hyperhidrosis are critically evaluated, including data from clinical trials with focus on possible side effects and long-term complications in dispute. Expert opinion: Hyperhidrosis often responds well to available therapies. Depending on the type of hyperhidrosis treatment should be topical/local or systemic. Most of the side effects are mild, transient and easily manageable. In case of systemic treatment with anticholinergics low dosing and up-titration of medication is necessary to avoid severe adverse effects. Concerns about the promotion of breast cancer and Alzheimer disease by topical aluminum salts are unsolved.
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Affiliation(s)
- Christine Hosp
- a Department of Dermatology, Venereology and Allergology , University Hospital Würzburg , Würzburg , Germany
| | - Henning Hamm
- a Department of Dermatology, Venereology and Allergology , University Hospital Würzburg , Würzburg , Germany
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Xie S, Wang K, Xu T, Guo XS, Shan XF, Cai ZG. Efficacy and safety of botulinum toxin type A for treatment of Frey's syndrome: evidence from 22 published articles. Cancer Med 2015; 4:1639-50. [PMID: 26310612 PMCID: PMC4673990 DOI: 10.1002/cam4.504] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/23/2015] [Accepted: 07/07/2015] [Indexed: 12/27/2022] Open
Abstract
Frey’s syndrome (FS) is an unavoidable sequela following the surgery of the parotid gland. Although several treatment methods are available, their efficacy is short term or accompanied by unacceptable complications. In the past two decades, botulinum toxin type A (BTXA) has been widely used to treat FS. Although several systematic reviews have been reported recently, they were conflicting and with obvious deficiencies. Thus, we performed an objectively systematic review to determine whether BTXA is an effective and safe treatment for FS. A literature retrieval covering PubMed, Web of Science, Ovid, Embase and Cochrane library was performed on 16 January, 2015. Proportion meta-analysis and corresponding 95% confidence interval (CI) were performed to evaluate the efficacy and safety of BXTA in treatment of FS. A total of 499 records were retrieved and 22 articles with 23 studies were included after scrutiny by two independent authors. Statistical analyses regarding the effective rate, incidence of complications were used to estimate the efficacy and safety of BTXA. Our results suggested that the effective rate of BTXA for treatment of FS is 98.5% (95% CI = 0.971–0.994) and the incidence of complication is 3.6% (95% CI = 0.017–0.061). In conclusion, our study supports that BTXA produces meaningful benefits on the treatment of patients with FS. However, owing to lack of strong evidence, future studies with well-designed inclusion criteria and multicenter randomized controlled trials are needed to give more credible evidence, if possible.
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Affiliation(s)
- Shang Xie
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - Kan Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - Tao Xu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - Xue-Sheng Guo
- Department of Stomatology, Capital Medical University Pinggu Teaching Hospital, Beijing, 101200, China
| | - Xiao-Feng Shan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - Zhi-Gang Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
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Abstract
BACKGROUND Frey's syndrome is a rare disorder, the symptoms of which include sweating, flushing and warming over the preauricular and temporal areas following a gustatory stimulus. It often occurs in patients who have undergone parotidectomy, submandibular gland surgery, radical neck dissection, infection and traumatic injury in the parotid region, and is caused by the aberrant regrowth of facial autonomic nerve fibres. Currently there are several options used to treat patients with Frey's syndrome; for example, the topical application of anticholinergics and antiperspirants, and the intradermal injection of botulinum toxin. It is uncertain which treatment is most effective and safe. OBJECTIVES To assess the efficacy and safety of different interventions for the treatment of Frey's syndrome. SEARCH METHODS We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; ICTRP and additional sources for published and unpublished trials. The date of the search was 28 April 2014. SELECTION CRITERIA We included randomised or quasi-randomised controlled trials (RCTs) in participants diagnosed with Frey's syndrome using a clinical standard such as Minor's starch-iodine test. We planned to include trials in which participants received any intervention versus no treatment (observation) or an alternative intervention, with or without a second active treatment. Our primary outcome measures were success rate (as assessed clinically by Minor's starch-iodine test, the iodine-sublimated paper histogram method, blotting paper technique or another method) and adverse events. Our secondary outcome measure was success rate as assessed by patients (disappearance or improvement of symptoms). DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We identified no RCTs or quasi-RCTs that fulfilled the inclusion criteria. Our searches retrieved eight potentially relevant studies, but after assessment of the full-text reports we excluded all of them due to the absence of randomisation or because the patients did not have Frey's syndrome. We excluded one randomised controlled trial that compared two different doses of botulinum toxin in patients with Frey's syndrome because the comparator was not an alternative treatment. AUTHORS' CONCLUSIONS We are unable to establish the efficacy and safety of the different methods used for the treatment of Frey's syndrome.RCTs are urgently needed to assess the effectiveness of interventions for the treatment of Frey's syndrome. Future RCTs should include patients with Frey's syndrome of different ranges of severity and report these patients separately. Studies should investigate all possibly effective treatments (such as anticholinergics, antiperspirants and botulinum toxin) compared to control groups using different treatments or placebo. Subjective assessment of Frey's syndrome should be considered as one of the outcome measures.
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Affiliation(s)
- Chunjie Li
- West China Hospital of Stomatology, Sichuan University, State Key Laboratory of Oral DiseasesDepartment of Head and Neck OncologyNo. 14, Section Three, Ren Min Nan RoadChengduSichuanChina610041
| | - Fanglong Wu
- West China Hospital of Stomatology, Sichuan University, State Key Laboratory of Oral DiseasesDepartment of Oral and Maxillofacial SurgeryNo. 14, Section Three, Ren Min Nan RoadChengduChina610041
| | - Qi Zhang
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan UniversityDepartment of Oral Implantology, State Key Laboratory of Oral DiseasesNo. 14, Section Three, Ren Min Nan RoadChengduSichuanChina610041
| | - Qinghong Gao
- West China Hospital of Stomatology, Sichuan University, State Key Laboratory of Oral DiseasesDepartment of Oral and Maxillofacial SurgeryNo. 14, Section Three, Ren Min Nan RoadChengduChina610041
| | - Zongdao Shi
- West China Hospital of Stomatology, Sichuan University, State Key Laboratory of Oral DiseasesDepartment of Oral and Maxillofacial SurgeryNo. 14, Section Three, Ren Min Nan RoadChengduChina610041
| | - Longjiang Li
- West China Hospital of Stomatology, Sichuan University, State Key Laboratory of Oral DiseasesDepartment of Head and Neck OncologyNo. 14, Section Three, Ren Min Nan RoadChengduSichuanChina610041
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Glaser DA, Galperin TA. Botulinum Toxin for Hyperhidrosis of Areas Other than the Axillae and Palms/Soles. Dermatol Clin 2014; 32:517-25. [DOI: 10.1016/j.det.2014.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Botulinum Toxin (BT) is a natural molecule produced during growth and autolysis of bacterium called Clostridium botulinum. Use of BT for cosmetic purposes has gained popularity over past two decades, and recently, other therapeutic uses of BT has been extensively studied. BT is considered as a minimally invasive agent that can be used in the treatment of various orofacial disorders and improving the quality of life in such patients. The objective of this article is to review the nature, mechanism of action of BT, and its application in various head and neck diseases.
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Affiliation(s)
- P S Shilpa
- Department of Oral Medicine and Radiology, Vydehi Institute of Dental Sciences, No. 82, EPIP Area, White Field, Bangalore, India
| | - Rachna Kaul
- Department of Oral Medicine and Radiology, Vydehi Institute of Dental Sciences, No. 82, EPIP Area, White Field, Bangalore, India
| | - Nishat Sultana
- Department of Oral Medicine and Radiology, Vydehi Institute of Dental Sciences, No. 82, EPIP Area, White Field, Bangalore, India
| | - Suraksha Bhat
- Department of Oral Medicine and Radiology, Vydehi Institute of Dental Sciences, No. 82, EPIP Area, White Field, Bangalore, India
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Gong TK, Kim DW. Effectiveness of oral glycopyrrolate use in compensatory hyperhidrosis patients. Korean J Pain 2013; 26:89-93. [PMID: 23342216 PMCID: PMC3546219 DOI: 10.3344/kjp.2013.26.1.89] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 11/28/2012] [Accepted: 11/29/2012] [Indexed: 11/05/2022] Open
Abstract
Compensatory hyperhidrosis or reflex hyperhidrosis is the increase in sweating in the postoperative stage of thoracic sympathectomy or lumbar sympathectomy. It shares several features with anxiety disorders and has a negative impact on a patient's quality of life. Oralglycopyrrolate is one of the treatment options available. This study reviewed case notes in a series of 19 patients with compensatory hyperhidrosis. We made a comparison between the Milanez de Campos score of a pre-glycopyrrolate medication group and the Milanez de Campos score of a post-glycopyrrolate medication group. The Beck Depression Inventory (BDI) score, Beck Anxiety Inventory (BAI) score, and autonomic nervous system (ANS) scale score were also compared between the pre-medication and post-medication groups. In the post-glycopyrrolate medication group, there was decrease in the Milanez de Campos score, BAI score, and BDI score (P < 0.05). But no meaningful change was seen in the ANS score in the post-glycopyrrolate medication group (P > 0.05). Glycopyrrolate is an effective medication in the treatment of compensatory hyperhidrosis that, can alleviate anxiety and improve patients' quality of life.
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Affiliation(s)
- Tai Kyung Gong
- Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, Korea
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Steffen A. Botulinumtoxin für die Behandlung sekretorischer Störungen im Kopf-Hals-Bereich. HNO 2012; 60:484-9. [DOI: 10.1007/s00106-012-2498-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Botulinum toxin for Frey's syndrome: a closer look at different treatment responses. The Journal of Laryngology & Otology 2011; 126:185-9. [PMID: 22018335 DOI: 10.1017/s0022215111002581] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Botulinum toxin is a widely accepted, effective treatment for Frey's syndrome. While some patients need only one injection, others require repeated treatments. We aimed to describe the clinical features of patients with a more challenging treatment course. DESIGN Literature review and retrospective analysis of eight consecutive patients treated at a university hospital. SUBJECTS These patients' treatment responses were categorised (using our own system) and compared with those of 25 published cases. RESULTS Combined analysis identified no significant correlation between treatment response and age, gender or the extent of primary salivary gland surgery. There was no significant correlation between botulinum toxin dosage and time between treatments. CONCLUSION Frey's syndrome should be viewed as a dynamic process in which the stimulus for aberrant reinnervation of parasympathetic nerve fibres can be reduced, in some patients, with higher botulinum toxin dose injections to the treated areas. However, responses are unpredictable, and relapses may occur at different time points and in different areas.
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Cantarella G, Berlusconi A, Mele V, Cogiamanian F, Barbieri S. Treatment of Frey's syndrome with botulinum toxin type B. Otolaryngol Head Neck Surg 2010; 143:214-8. [PMID: 20647122 DOI: 10.1016/j.otohns.2010.04.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Revised: 03/24/2010] [Accepted: 04/08/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Frey's syndrome is a frequent sequela of parotidectomy, causing facial sweating and flushing because of gustatory stimuli. Although botulinum toxin type A has become first-line therapy for Frey's syndrome, some patients become resistant. In this study, we investigated whether another serotype, botulinum toxin type B, might be an effective alternative. STUDY DESIGN Case series with planned data collection. SETTING Otolaryngology department in a university hospital. SUBJECTS AND METHODS Seven patients aged 30 to 68 years, with severe Frey's syndrome, underwent the Minor test and had 80 U of botulinum toxin type B per cm(2) (mean total dose, 2354 U) injected intracutaneously in the mapped area of gustatory sweating. All patients were followed up for 12 months. RESULTS One month after treatment, six of the seven patients reported that gustatory sweating and flushing had resolved, and, in the remaining patient, these symptoms had decreased. The Minor test confirmed a significant improvement. The subjective benefits remained stable for six months in four patients and for nine months in the remaining three patients; 12 months after treatment, all patients still reported some improvement. CONCLUSION Botulinum toxin type B afforded symptomatic relief in a small sample of patients with Frey's syndrome and might be considered a potential alternative to botulinum toxin type A.
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Affiliation(s)
- Giovanna Cantarella
- Department of Otolaryngology, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Use of hypertonic saline in the management of parotid fistulae and sialocele: a report of 2 cases. J Maxillofac Oral Surg 2009; 8:64-7. [PMID: 23139474 DOI: 10.1007/s12663-009-0016-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Accepted: 01/26/2009] [Indexed: 10/20/2022] Open
Abstract
Parotid fistula is a well known complication of parotidectomy or penetrating injury of the parotid gland. Fistulae may be internal or external, but simple internal fistulae are of no surgical interest. In cases of external fistulae, the principles of management aim at the return of normal parotid function in both acute and chronic parotid injury, but sometimes the alternative is to depress parotid secretions to allow natural healing process to seal the injury.The paper highlights the indications, techniques, advantages and disadvantages of using osmotic sclerosant for the management of parotid fistulae. We used warm hypertonic saline injections within the glandular substance to cause rapid fibrosis of the gland in 2 patients of chronic parotid fistulae.This technique is a simple and effective method of dealing with salivary leak. Its ease of performance, effectiveness; minimal surgical risk and minor cost are the advantages over other available options.
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Laing TA, Laing ME, O'Sullivan ST. Botulinum toxin for treatment of glandular hypersecretory disorders. J Plast Reconstr Aesthet Surg 2008; 61:1024-8. [PMID: 18619934 DOI: 10.1016/j.bjps.2008.03.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Revised: 02/23/2008] [Accepted: 03/06/2008] [Indexed: 11/19/2022]
Abstract
SUMMARY The use of botulinum toxin to treat disorders of the salivary glands is increasing in popularity in recent years. Recent reports of the use of botulinum toxin in glandular hypersecretion suggest overall favourable results with minimal side-effects. However, few randomised clinical trials means that data are limited with respect to candidate suitability, treatment dosages, frequency and duration of treatment. We report a selection of such cases from our own department managed with botulinum toxin and review the current data on use of the toxin to treat salivary gland disorders such as Frey's syndrome, excessive salivation (sialorrhoea), focal and general hyperhidrosis, excessive lacrimation and chronic rhinitis.
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Affiliation(s)
- T A Laing
- Department of Plastic and Reconstructive Surgery, Cork University Hospital, Cork, Ireland
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Botulinum toxin A for quality of life improvement in post-parotidectomy gustatory sweating (Frey's syndrome). The Journal of Laryngology & Otology 2008; 122:1100-4. [DOI: 10.1017/s0022215108001771] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:To measure patient-reported quality of life before and after botulinum toxin A treatment of post-parotidectomy Frey's syndrome (gustatory sweating).Patients and methods:A questionnaire concerning functional, social and emotional aspects of Frey's syndrome (14 questions, with responses on a zero to three point scale) was administered to 17 patients (13 women and four men) before and one month after intradermal injection of botulinum toxin A. Parotidectomy had been performed one to 19 years previously, for benign (n = 10) or malignant (n = 7) tumours, with gustatory sweating occurring a median of 15 months after surgery (range: one month to 14 years). Pre- and post-treatment quality of life scores were compared using Wilcoxon's test (p < 0.05).Results:Patients' reported functional quality of life improved significantly (p = 0.0004). Their social and emotional scores were not significantly modified (p = 0.155 and 0.142, respectively). Seven patients (41 per cent) found the injections painful, but all patients said that the effects were beneficial, that they would undergo new injections if necessary and that they would recommend this treatment to other patients. The benefit lasted over 1.5 years for 60 per cent of patients. No correlation was found between duration of the effect and the extent of parotidectomy (p = 0.067).Conclusions:Botulinum toxin A significantly improved patients' functional quality of life, without significant improvement in their social or emotional quality of life, according to our questionnaire results. The duration of the effect was longer than the reported physiological effect of botulinum toxin A on acetylcholine receptors.
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Head and Neck Cancer. Oncology 2007. [DOI: 10.1007/0-387-31056-8_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Solish N, Bertucci V, Dansereau A, Hong HCH, Lynde C, Lupin M, Smith KC, Storwick G. A comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: recommendations of the Canadian Hyperhidrosis Advisory Committee. Dermatol Surg 2007; 33:908-23. [PMID: 17661933 DOI: 10.1111/j.1524-4725.2007.33192.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hyperhidrosis can have profound effects on a patient's quality of life. Current treatment guidelines ignore disease severity. OBJECTIVE The objective was to establish clinical guidelines for the recognition, diagnosis, and treatment of primary focal hyperhidrosis. METHODS AND MATERIALS A working group of eight nationally recognized experts was convened to develop the consensus statement using an evidence-based approach. RECOMMENDATIONS An algorithm was designed to consider both disease severity and location. The Hyperhidrosis Disease Severity Scale (HDSS) provides a qualitative measure that allows tailoring of treatment. Mild axillary, palmar, and plantar hyperhidrosis (HDSS score of 2) should initially be treated with topical aluminum chloride (AC). If the patient fails to respond to AC therapy, botulinum toxin A (BTX-A; axillae, palms, soles) and iontophoresis (palms, soles) should be the second-line therapy. In severe cases of axillary, palmar, and plantar hyperhidrosis (HDSS score of 3 or 4), both BTX-A and topical AC are first-line therapy. Iontophoresis is also first-line therapy for palmar and plantar hyperhidrosis. Craniofacial hyperhidrosis should be treated with oral medications, BTX-A, or topical AC as first-line therapy. Local surgery (axillary) and endoscopic thoracic sympathectomy (palms and soles) should only be considered after failure of all other treatment options. CONCLUSIONS These guidelines offer a rapid method to assess disease severity and to treat primary focal hyperhidrosis according to severity.
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Affiliation(s)
- Nowell Solish
- Division of Dermatology, New Women's College Hospital, Toronto, Ontario, Canada.
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A Comprehensive Approach to the Recognition, Diagnosis, and Severity-Based Treatment of Focal Hyperhidrosis. Dermatol Surg 2007. [DOI: 10.1097/00042728-200708000-00003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Glaser DA. The use of botulinum toxins to treat hyperhidrosis and gustatory sweating syndrome. Neurotox Res 2006; 9:173-7. [PMID: 16785115 DOI: 10.1007/bf03033936] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hyperhidrosis is a chronic condition characterized by excessive sweating. Recent studies report that it affects approximately 2.8% of the population and typically begins during adolescence. Gustatory sweating usually occurs after parotid gland injury or surgery, and both disorders can be debilitating for those who are affected. Both diseases respond very well to botulinum toxin therapy and this article will review the use of botulinum toxins, including the serotypes used, dosing, and complications.
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Affiliation(s)
- D A Glaser
- Department of Dermatology, Saint Louis University School of Medicine, MO 63104, USA.
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Wang CC, Wang CP. Preliminary experience with botulinum toxin type A intracutaneous injection for Frey's syndrome. J Chin Med Assoc 2005; 68:463-7. [PMID: 16265860 DOI: 10.1016/s1726-4901(09)70075-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Gustatory sweating, the main symptom of Frey's syndrome, usually occurs after parotid gland surgery. Numerous medical and surgical treatments have been proposed to treat this condition, but there are various drawbacks. Botulinum toxin type A intracutaneous injection is a relatively new treatment modality; its use has never been reported in Taiwan. Here, we present our preliminary experience with this technique and review the literature. METHODS Between March 2002 and June 2005, 10 consecutive patients with severe gustatory sweating were managed with intracutaneous injection of botulinum toxin type A for a total of 16 times. The affected skin was visualized by Minor's starch-iodine test and then recorded. The interinjection distance was 1 cm and a mean dose of 46.4 U (at a concentration of 2.5 U/0.1 mL) was used. RESULTS In all 10 cases, gustatory sweating improved within 2 days after injection, with no side effects. Patients in whom the first 13 injections were performed experienced recurrence of gustatory sweating. Mean duration of effectiveness was 9.3 months; the shortest duration of effectiveness was 2 months and the longest was 28 months. One patient also had gustatory flushing, but this symptom did not improve even after 3 treatments. CONCLUSION Intracutaneous injection of botulinum toxin type A is a highly reliable, effective, safe, and minimally invasive treatment for gustatory sweating. Some patients had long-lasting therapeutic results. We recommend it as a valuable treatment option for severe cases of gustatory sweating. However, in our experience, it had no effect on facial skin flushing. Therefore, in addition to acetylcholine, there might be other neurotransmitters that are responsible for skin vasodilatation.
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Affiliation(s)
- Chen-Chi Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
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Acher-Chenebaux A, Maillard H, Potier A, Lejoyeux P, Célérier P. Traitement d’un syndrome de Frey par des injections de toxine botulique A. Ann Dermatol Venereol 2005; 132:703-5. [PMID: 16230925 DOI: 10.1016/s0151-9638(05)79423-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Injuries to the buccal region of the face can carry multiple complications due to the complex anatomy that lies within. The facial nerve and the parotid duct can be easily injured by sharp or penetrating trauma to the cheek. The purpose of this paper is to present the full spectrum of current treatment modalities available to manage these injuries. The anatomy of the parotid gland and duct are described, and surgical techniques and therapeutic alternatives for the immediate and delayed treatment of the parotid duct injuries are reviewed. Clinical cases are presented to illustrate the treatment options outlined.
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Affiliation(s)
- Mark J Steinberg
- Division of Oral and Maxillofacial Surgery and Dental Medicine, Loyola University Medical Center, Maywood, IL 60153, USA.
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Hornberger J, Grimes K, Naumann M, Glaser DA, Lowe NJ, Naver H, Ahn S, Stolman LP. Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol 2004; 51:274-86. [PMID: 15280848 DOI: 10.1016/j.jaad.2003.12.029] [Citation(s) in RCA: 258] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The treatment of focal hyperhidrosis and drooling with neurolysis of the neuroglandular junction is a relatively new and useful technique for managing such obvious conditions and improving the patient's quality of life. The treatment is safe, minimally invasive, and an effective alternative to other treatment modalities.
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Affiliation(s)
- Ib R Odderson
- Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA.
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Guntinas-Lichius O. Management of Frey's syndrome and hypersialorrhea with botulinum toxin. Facial Plast Surg Clin North Am 2003; 11:503-13. [PMID: 15062255 DOI: 10.1016/s1064-7406(03)00075-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Botulinum toxin (BTX) is a safe and reliable drug for the treatment of Frey's syndrome and hypersialorrhea. Currently, the intradermal injection of BTX is the standard treatment of Frey's syndrome. A disappearance of Frey's syndrome for 1 to 1.5 year could almost be promised. Recently, BTX was introduced for the treatment of hypersialorrhea. Although some questions exist about the optimal dosage and the type of major salivary glands that should be treated, hypersialorrhea was reduced in almost all affected children and adults for up to 6 months by using ultrasound-guided intraglandular BTX injections.
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Affiliation(s)
- Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, D-50924 Cologne, Germany.
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Teive HAG, Troiano AR, Robert F, Iwamoto FM, Maniglia JJ, Mocellin M, Werneck LC. Botulinum toxin for treatment of Frey's syndrome: report of two cases. ARQUIVOS DE NEURO-PSIQUIATRIA 2003; 61:256-8. [PMID: 12806506 DOI: 10.1590/s0004-282x2003000200017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Frey's syndrome is a phenomenon of hemifacial flushing and sweating after gustatory stimulus, usually secondary to surgical trauma over the parotid gland, although other injury mechanisms may be seen. It is accepted as a result of aberrant regeneration of facial autonomic nerve fibers. Treatment evolved from ineffective medical and surgical approaches to botulinum toxin. We evaluate the effectiveness and safety of botulinum toxin in the treatment of this complication in two patients.
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Affiliation(s)
- Hélio A G Teive
- Movement Disorders Unit, Neurology Service, Hospital de Clínicas of Federal university of Paraná, Curitiba PR, Brazil.
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