Selection of safe parameters for jet injection of botulinum toxin in palmar hyperhidrosis

Current trends in needle-free jet injection: an update

Background

Jet injection can be defined as a needle-free drug delivery method in which a high-speed stream of fluid impacts the skin and delivers a drug. Despite 75 years of existence, it never reached its full potential as a strategic tool to deliver medications through the skin.

Objective

The aim of this review was to evaluate and summarize the evolution of jet injection intradermal drug delivery method including technological advancements and new indications for use.

Methods

A review of the literature was performed with no limits placed on publication date.

Results

Needleless injectors not only reduce pain during drug delivery but also confine the drug more evenly in the dermis. Understanding skin properties of the injection site is a key factor to obtain optimal results as well as setting the right parameters of the jet injector. Until the advent of disposable jet injectors/cartridges, autoclaving of the injector remains the only reliable method to eliminate the risk of infection. Needle-free intradermal injection using corticosteroids and/or local anesthetics is well documented with promising indications being developed.

Limitations

Limitations of the review include low-quality evidence, small sample sizes, varying treatment parameters, and publication bias.

Conclusion

New developments may help reconsider the use of jet injection technology. Future studies should focus on measurable optimized parameters to insure a safe and effective outcome.

Treatment of Palmar Hyperhidrosis With Needle Injection Versus Low-Pressure Needle-Free Jet Injection of OnabotulinumtoxinA: An Open-Label Prospective Study

BACKGROUND

OnabotulinumtoxinA (OnabotA) injections are effective to treat palmar hyperhidrosis (HH) but are quite painful.

OBJECTIVE

To evaluate efficacy and pain of OnabotA injection using a needle-free jet apparatus compared with the traditional needle injection to treat palmar HH.

METHODS

Twenty patients were recruited for a prospective open-label study. Their right hand was injected with 1% lidocaine with a jet injector, after which OnabotA was injected with a needle. The left hand was injected with OnabotA directly using the jet injector. Pain scores were recorded for both techniques. At 0, 1, 3, and 6 months, severity of palmar HH was evaluated with the Hyperhidrosis Disease Severity Scale (HDSS).

RESULTS

One point reduction in the HDSS score at 1 month showed no statistical difference between both hands (p = .451). However, the HDSS score at 1 month from baseline dropped by 1.6 for the hand treated with traditional needle injection of OnabotA compared with 1.25 for the hand treated with jet injections (p = .031). There was no statistical difference in the pain on injection with both techniques (p = .1925).

CONCLUSION

This study demonstrates effective and relatively painless use of a low-pressure jet injector for OnabotA in palmar HH.

Treatment of nail psoriasis with intralesional triamcinolone acetonide using a needle-free jet injector: a prospective trial

BACKGROUND

Treating nail psoriasis is challenging. Corticosteroid matrix injection with needle is a conventional treatment but pain is often a limitation.

OBJECTIVE

Evaluate efficacy and safety of triamcinolone acetonide needle-free injection with the Med-Jet MBX in psoriatic fingernail.

METHODS

Seventeen patients were enrolled between January 2012 and January 2013. Four treatments sessions were scheduled every 4 ± 1 weeks. Clinical efficacy was evaluated according to Nail Psoriasis Severity Index (NAPSI) score of target nail differences before and after the treatment.

RESULTS

Mean baseline NAPSI score was 6.5 on an 8-point scale (95% confidence interval [CI] 5.652-7.348) and mean final NAPSI score was 2.8 on an 8-point scale (95% CI 1.859-3.741), demonstrating statistically significant treatment efficacy (p = .0007). NAPSI score for target nail from baseline to end of treatment was decreased by 46.25%.

CONCLUSION

Treatment with triamcinolone acetonide delivered by Med-Jet MBX is a safe, minimally painful and effective treatment for nail psoriasis.