A Case of Foul Genital Odor Treated with Botulinum Toxin A

Comparison of Effectiveness and Associated Complications Between Conventional Subdermal Excision and Hydrosurgery (VersajetTM) for Osmidrosis

BACKGROUND

Recent studies have shown hydrosurgery (Versajet TM II) is a simple and effective tool with reduced complications in surgical treatment of osmidrosis. Since then, hydrosurgery has been widely used for osmidrosis. However, we have experienced that some complications often occur in patients treated with hydrosurgery.

OBJECTIVE

We hypothesized that using a hydrosurgery could lead to excessive resection of the tightly attached apocrine glands and thus more complications. We aimed at evaluating the effectiveness and associated complications of the hydrosurgery method for osmidrosis were compared with those of conventional methods with two parallel incisions.

METHODS & MATERIALS

We retrospectively analyzed 31 and 16 patients who underwent conventional and hydrosurgery methods, respectively, for osmidrosis from 2010 to 2020. Two parallel long incisions were identical in both groups. Early complications (hematoma, seroma, wound dehiscence, skin necrosis, revision, scar contracture), late complications (scar, pigmentation, comedones/milia, and sebaceous cysts), and effectiveness (subjective satisfaction, malodor elimination, reduced hair growth, and sweating elimination) were evaluated.

RESULTS

Skin necrosis was significantly more frequent in the hydrosurgery group than in the conventional group (p = 0.036). No other significant differences were found between the two groups in terms of other complications and effectiveness. As a result of comparing effectiveness, subjective satisfaction (p = 0.306), malodor elimination (p = 1.000), reduced hair growth (p=1.000), and sweating elimination (p = 0.742) did not show any significant difference between the two groups.

CONCLUSION

Osmidrosis treatment with the use of VERSAJET™ Hydrosurgery System yielded similar and satisfactory results as the conventional subdermal excision method. The incidence of skin necrosis was higher in the hydrosurgery group than in the conventional group with two parallel incisions.

LEVEL OF EVIDENCE III

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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.

Botulinum Toxin Off-Label Use in Dermatology: A Review

BACKGROUND

Botulinum toxin is a neurotoxin produced by the bacterium Clostridium botulinum which causes a flaccid muscle paralysis. It is currently used for aesthetic treatments and in the focal hyperhidrosis. Recently, botulinum toxin has also been used experimentally in many other dermatological conditions with good results.

OBJECTIVE

To review and analyze the possible botulinum toxin off-label applications published.

METHODS

A retrospective review of the published data was conducted.

CONCLUSIONS

this potent drug can lead to several off-label indications of interest for dermatologists. Further clinical trials are still needed to better understand the real efficacy and safety of these applications and to standardize injection and dose protocols.

Botulinum toxin, Quo Vadis?

Botulinum toxin (BTX), derived from the exotoxin of Clostridium botulinum, cleaves Soluble N-ethylmaleimide-sensitive factor-Attachment protein REceptor (SNARE) proteins, causing chemodenervation of cholinergic neurons. BTX also inhibits exocytosis of vesicles containing norepinephrine, glutamate, substance P and calcitonin gene-related peptide (CGRP) and inhibits expression of the vanilloid receptor. Clinical applications of BTX, which include the treatment of overactive skeletal and smooth muscles, hypersecretory and painful disorders, have increased exponentially since it was first used clinically to treat strabismus more than two decades ago. In this editorial, we discuss reports of new therapeutic indications of BTX, and propose new areas for research.