Intracutaneous botulinum toxin A versus ablative therapy of Hailey-Hailey disease--a case report.
BACKGROUND
Hailey-Hailey disease is an autosomal-dominant blistering disease affecting the intertriginous skin. Dermabrasion and ablative laser treatment are known to be curative. Sweating is a common aggravating factor. Botulinum toxin A (BTXA) has been shown to inhibit sudoriferic nerves.


OBJECTIVE
To evaluate whether a treatment with BTXA induces remissions and can compete with ablative therapy. To compare dermabrasion with erbium:YAG laser therapy.


METHODS
Case report with side-by-side comparison. We used intracutaneous BTXA on both sides of the submammary region. Four days later a limited area of 25 cm(2) on each side was treated with either dermabrasion or erbium:YAG laser. The follow-up was 12 months.


RESULTS
Wound healing was complete within 7 days after erbium:YAG laser and two weeks after dermabrasion. Areas treated with BTXA alone also showed complete remission within two weeks. During a follow-up, no relapse occurred with either treatment.


CONCLUSIONS
BTXA is capable of inducing remissions of Hailey-Hailey disease without abrasion for at least 12 months. Among ablative treatments, erbium: YAG laser therapy leads to a more rapid wound closure than dermabrasion, with both causing complete remissions.
Konrad
H
H
Department of Dermatology and Allergology, University of Jena, Germany.
Karamfilov
T
T
Wollina
U
U
D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003869:Dermabrasion / Q000379:methods*; D005260:Female; D006801:Humans; D007271:Injections, Intradermal; D053685:Laser Therapy; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D016506:Pemphigus, Benign Familial / Q000628:therapy*; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A