Treatment of dyshidrotic hand dermatitis with intradermal botulinum toxin.
BACKGROUND
Botulinum toxin (Btx A) has recently been used in the treatment of focal hyperhidrosis. Hyperhidrosis is also an aggravating factor in nearly 40% of patients with dyshidrotic hand eczema.


OBJECTIVE
The objective of this study was to evaluate the effect of intradermal injections of Btx A on dermatitis in patients with vesicular hand dermatitis.


METHODS
Ten patients with vesicular dermatitis were treated on one hand with intradermal Btx A (mean, 162 U BOTOX, Allergan Pharmaceuticals, Irvine, Calif) with the untreated side as a control.


RESULTS
Self-assessment at follow-up 5 to 6 weeks after injection on a 5-point scale (none, slight, moderate, good, or very good effect) showed that 7 of 10 patients experienced good or very good effect. A decrease in itching was shown with a visual linear analogue scale (VAS) for itching, with mean 39% on the treated side compared with an increase by 52% on the untreated side. These findings were supported by the evaluation of clinical signs. Six of 7 patients who experienced good or very good effect also had aggravating hand sweating or worsening during the summer.


CONCLUSIONS
Btx A can be a valuable alternative for patients with treatment-refractory hand eczema of the vesicular type, especially with hyperhidrosis or worsening during the summer.
Swartling
Carl
C
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
Naver
Hans
H
Lindberg
Magnus
M
Anveden
Ingegard
I
D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D011146:Eczema, Dyshidrotic / Q000188:drug therapy*; D005260:Female; D006225:Hand; D006801:Humans; D007271:Injections, Intradermal; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D011446:Prospective Studies; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A