Treatment of hyperhidrosis with Botox (onabotulinumtoxinA): Development, insights, and impact

Non-cosmetic use of botulinum toxin in surgical conditions

Botulinum toxin (BTX) is a neurotoxin that has an ability to create a fully reversible relaxation of muscles through decreased release of acethylcholin. It also has an effect on the cholinergic autoimmune nervous system, and it can reduce pain sensitization. BTX is widely used in cosmetic treatments. In recent years, BTX has increasingly been used to treat several medical and surgical conditions. In many cases, this is despite weak evidence and without approval from the European Medicine Agency (EMA). This narrative review describes how BTX is used in the different surgical specialties and provides a brief overview of the use of BTX for non-cosmetic surgical conditions.

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.

Treatment of Primary Axillary Hyperhidrosis with Two Doses of Botulinum Toxin A-Observational Study

Hyperhidrosis (HH) is defined as the production of more sweat than is necessary for its thermoregulatory function, negatively affecting patients' quality of life and interfering with their social, work and family life. In this context, the aim of thisstudy was to evaluate the efficacy of two different doses of botulinum toxin type A (50 or 100 units) in each axilla in severe primary axillary hyperhidrosis. A descriptive, observational, cross-sectional and post-authorisation study was conducted onpatients referred to our department.Thirty-one patients with severe primary axillary hyperhidrosis were included, some of whom received more than one infiltration during the follow-up period, performing a total of 82 procedures. They were assigned by simple random sampling to two types of treatment: infiltration of 50 or 100 units (U) of botulinum toxin A per axilla.Hyperhidrosis severity was assessed using the Hyperhidrosis Disease Severity Scale (HDSS), and quality of life was assessed using the Dermatology Life Quality Index (DLQI) questionnaire. Onabotulinum toxin A infiltration reduced the severity of hyperhidrosis and improved the quality of life of the treated patients, with no significant differences between the two groups.

Clinical Conditions Targeted by OnabotulinumtoxinA in Different Ways in Medicine

OnabotulinumtoxinA (BT-A) is used in different medical fields for its beneficial effects. BT-A, a toxin originally produced by the bacterium Clostridium botulinum, is widely known for its ability to temporarily paralyze muscles by blocking the release of acetylcholine, a neurotransmitter involved in muscle contraction. The literature continually reports new hypotheses regarding potential applications that do not consider blockade of acetylcholine release at the neuromuscular junction as a common pathway. In this opinion article, it is our aim to investigate the different pathway targets of BT-A in different medical applications. First of all, the acetylcholine effect of BT-A is used to reduce wrinkles for cosmetic purposes, in the treatment of urological problems, excessive sweating, temporomandibular joint disorders, obesity, migraine, spasticity in neurological diseases, and in various cases of muscle overactivity such as cervical dystonia, blepharospasm, and essential head tremor. In another potential pathway, glutamate A, CGRP, and substance P are targeted for pain inhibition with BT-A application in conditions such as migraine, trigeminal neuralgia, neuropathic pain, and myofascial pain syndrome. On the other hand, as a mechanism different from acetylcholine and pain mediators, BT-A is used in the treatment of hair loss by increasing oxygenation and targeting transforming growth factor-beta 1 cells. In addition, the effect of BT-A on the apoptosis of cancer cells is also known and is being developed. The benefits of BT-A applied in different doses to different regions for different medical purposes are shown in literature studies, and it is also emphasized in those studies that repeating the applications increases the benefits in the long term. The use of BT-A continues to expand as researchers discover new potential therapeutic uses for this versatile toxin.

Periorbital Swellings Associated with Neurotoxin Injections

Complications due to facial injectables such as neurotoxin injections can commonly occur and are underreported. Those complications may result from poor injection techniques, lack of proper knowledge about the anatomy, improper patient selection, and the use of counterfeit products. The lack of regulations, along with improper awareness, may jeopardize the quality of the aesthetic treatment provided to the patients. This case report helps in raising awareness about possible complications arising from the use of counterfeit products in the aesthetic industry.

Longitudinal Assessment of Facial Hyperhidrosis Management: Evaluating the Utility and Quality of Life Improvements following Botulinum Toxin Injection

Facial hyperhidrosis is a debilitating condition that can severely impact the quality of life. This study aimed to assess the long-term utility of Botulinum toxin type A therapy (BTA) for facial hyperhidrosis and its impact on quality of life over a one-year period. Conducted at the Pius Brinzeu Clinical Emergency Hospital in Timisoara, Romania, this longitudinal observational study involved 77 adult patients with primary facial hyperhidrosis. Participants received two sessions of Botulinum toxin injections (50 U IncoBTX-A each) and were evaluated at baseline, 6 months, and 12 months using the Hyperhidrosis Disease Severity Scale (HDSS), WHOQOL-BREF, Dermatology Life Quality Index (DLQI), and a bespoke survey. The study demonstrated significant reductions in HDSS scores from 3.6 ± 0.5 to 1.2 ± 0.8 post-treatment, sustained at 1.3 ± 0.6 at 12 months (p-value < 0.001). DLQI scores markedly decreased from 24.8 ± 4.2 to 6.2 ± 2.1 post-treatment, stabilizing at 6.5 ± 2.5 at 12 months (p-value < 0.001). Sweat production significantly dropped from 0.75 g ± 0.15 to 0.18 g ± 0.07 per 15 min (p-value < 0.001). WHOQOL-BREF scores improved notably in the mental domain from 66.7 ± 6.1 to 70.8 ± 5.2 at 12 months (p-value < 0.001), with physical and social domains also showing significant improvements. Correlation analysis revealed strong negative correlations between DLQI total score and HDSS (rho = -0.72, p-value < 0.001) and sweat production (rho = -0.68, p-value < 0.001). Regression analysis indicated significant predictors for DLQI total score, including HDSS (B Coefficient = -3.8, p-value < 0.001) and sweat production (B Coefficient = -2.2, p-value < 0.001). BTA therapy significantly improved the quality of life in facial hyperhidrosis patients, with lasting effects on symptom severity, sweat production, and quality of life domains. The correlation and regression analyses further substantiated the treatment's impact on both physical and psychological aspects. These findings advocate Botulinum toxin as a viable long-term treatment for facial hyperhidrosis.

Efficacy and Safety Analysis of Botox Application and Iatrogenic Botulism: Panacea or Peril?

Clostridium botulinum toxin-A (BoNT-A) creates temporary paralysis in the muscles by acting on the muscle-nerve junction. It is injected into the mimic muscles when a decrease in the movements of the mimic muscles is desired. Despite many favorable applications, the use of BoNT-A is not without drawbacks. Although there is no expected serious side effect on health in BoNT-A treatments, various problems can be encountered in patients treated for aesthetic purposes. Botulism is a rare but potentially life-threatening syndrome, which is caused by the toxin produced by the bacterium Clostridium botulinum, which acts on the nervous system, vegetative forms of C. botulinum can only survive in anaerobic conditions, while spore forms are common in nature and can withstand harsh conditions. Botulism can stem from bacterial spores which release toxin in the body; in the form of enteric botulism, and wound botulism. The cases that develop 'iatrogenic botulism' after such procedures are usually those receiving high-dose toxin for therapeutic purposes. The treatment of botulism mainly consists of anti-toxin therapy and, if necessary, intensive care to prevent organ failures, including respiratory support. This article aims to cover all these issues related to botulism and other adverse outcomes related to BoNT-A injection in light of the most recent literature.