Botulinum Toxin Treatment of Autonomic Disorders: Focal Hyperhidrosis and Sialorrhea

Abstract

Primary focal hyperhidrosis is a common autonomic disorder that significantly impacts quality of life. It is characterized by excessive sweating confined to circumscribed areas, such as the axillae, palms, soles, and face. Less frequent types of focal hyperhidrosis secondary to underlying causes include gustatory sweating in Frey's syndrome and compensatory sweating in Ross' syndrome and after sympathectomy. Approval of onabotulinumtoxinA for severe primary axillary hyperhidrosis in 2004 has revolutionized the treatment of this indication. Meanwhile further type A botulinum neurotoxins like abobotulinumtoxinA and incobotulinumtoxinA, as well as the type B botulinum neurotoxin rimabotulinumtoxinB are successfully used off-label for axillary and various other types of focal hyperhidrosis. For unexplained reasons, the duration of effect differs considerably at different sites. Beside hyperhidrosis, botulinum neurotoxin is also highly valued for the treatment of sialorrhea affecting patients with Parkinson's disease, cerebral palsy, amyotrophic lateral sclerosis, motor neuron disease, and other neurologic conditions. With correct dosing and application, side effects are manageable and transient.

New trends in botulinum toxin use in dermatology

“…Data concerning plantar treatment with BoNT are scarce [ 29 ]. Doses employed vary from 50 to 250 IU of onabotulinumtoxinA per plantar area with effects lasting 3–6 months [ 30 ].…”

Treatment of post-traumatic chin deformities using bilateral botulinum toxin injections

“…Since then, botulinum toxin has been used for aesthetic purposes in diverse anatomical regions, including the eye, forehead, calf, and trapezius muscle. Botulinum toxin has also been used for therapeutic purposes in treating conditions such as sialocele, hyperhidrosis, facial spasms, and facial asymmetry [5]. Botulinum toxin is a common treatment for correcting facial asymmetries, particularly in cases of hemifacial palsy in which BoNT-A injections on the contralateral side are an effective treatment [6].…”

Frontal Alopecia after Repeated Botulinum Toxin Type A Injections for Forehead Wrinkles: An Underestimated Entity?

“…BTXA activity of suppressing muscle contractility is utilized for the treatment of several neurogenic dysfunctions characterized by excessive or inappropriate muscle contractions, such as strabismus, blepharospasm or muscular dystonias [8], as well as for cosmetic purposes to improve facial lines [9]. Other important in-label and off-label uses of BTXA in dermatology are severe primary axillary hyperhidrosis and palmar hyperhidrosis, respectively, where the toxin is injected intradermally [10]. Side effects are usually the result of inexpert injection and can be avoided if the physician injecting BTXA is properly trained.…”