Botulinum toxin A in anal fissures: a modified technique.
BACKGROUND
Anal fissures are common and painful. Botulinum toxin A (BTXA) is considered to be the most potent non-surgical treatment; however, no attention has been paid to associated hyperhidrosis.


OBJECTIVE
To compare traditional BTXA treatment of muscular spasticity in anal fissures with combined treatment of spasticity and focal hyperhidrosis of the anal fold and perianal skin.


METHODS
Outpatient department of a dermatological hospital.


METHODS
Ten patients with chronic anal fissures (of more than 6 months duration who failed to respond to conservative treatment and who had refused surgery) associated with focal hyperhidrosis as assessed by Minor's sweat test were investigated in an open, two-armed trial. Intramuscular injections of 20-25 U BTXA (Botox) were performed in group A (n = 5). In group B (n = 5) those injections were combined with intracutaneous injection of 30-50 U BTXA to treat focal hyperhidrosis. Mean follow-up was 5 months.


RESULTS
Five of five patients in group B but only two of five patients in group A experienced a complete remission despite the fact that relief of pain was evident in eight of 10 patients within 2 weeks. Patient satisfaction with treatment was high but slightly better in group B.


CONCLUSIONS
This open trial suggests that combined therapy of both muscular spasticity and focal hyperhidrosis may provide better results than intramuscular injections alone in anal fissure therapy with BTXA.
Wollina
U
U
Department of Dermatology, Krankenhaus Dresden-Friedrichstadt, Dresden, Germany. Wollina-Uw@khdf.de
Konrad
H
H
D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005401:Fissure in Ano / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D006945:Hyperhidrosis / Q000150:complications / Q000188:drug therapy*; D007271:Injections, Intradermal; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy; D017060:Patient Satisfaction
D019274:Botulinum Toxins, Type A