title: Cryoanalgesia with dichlorotetrafluoroethane lessens the pain of botulinum toxin injections for the treatment of palmar hyperhidrosis.
abstract: BACKGROUND
  Hyperhidrosis is a troublesome problem that can be embarrassing in both social and professional situations. Botulinum toxin injections have proven efficacious in the treatment of hyperhidrosis. However, when treating palmar hyperhidrosis, pain at the injection site limits this therapy. We describe a method of cryoanalgesia using dichlorotetrafluoroethane to lessen the pain of botulinum toxin injections during the treatment of palmar hyperhidrosis.
  
  
  OBJECTIVE
  To show the successful use of dichlorotetrafluoroethane or Frigiderm in the treatment of palmar hyperhidrosis.
  
  
  METHODS
  This is a case report of a patient with a 20-year history of palmar hyperhidrosis who had previously tried several unsuccessful techniques to control pain during botulinum toxin injections to his palms. The left hand of the patient was pretreated with a spray of Frigiderm for 5 seconds before each of the botulinum injections. Two to 3 seconds of dichlorotetrafluoroethane at a distance of 2 to 4 inches were sprayed before each palmar injection. There was 1 to 2 seconds of frosting on the skin before the botulinum toxin was administered. After the botulinum toxin injection was administered, the patient was subjectively asked about pain during injection.
  
  
  RESULTS
  The patient subjectively reported a 75% decrease in the intensity of pain with the Frigiderm application, which he said made the injections much more tolerable. No epidermal changes were noted at the time of treatment or at the telephone follow-up visit. The patient presented for follow-up 3 months later. He stated that the sweating had minimally returned but that he had not yet returned to baseline.
  
  
  CONCLUSIONS
  The use of botulinum toxin for the treatment of palmar hyperhidrosis is often limited because of the pain of multiple injections. In this case report, we describe the successful use of cryoanalgesia with dichlorotetrafluoroethane or Frigiderm to lessen the pain of botulinum toxin injections during the treatment of palmar hyperhidrosis.
authors.affiliation: Department of Dermatology and Cutaneous Surgery/Division of Cosmetic Dermatology, University of Miami, Miami, Florida, USA. lsb@derm.net
authors.forename: Leslie
authors.initials: L
authors.lastname: Baumann
authors.forename: Stacey
authors.initials: S
authors.lastname: Frankel
authors.forename: Esperanza
authors.initials: E
authors.lastname: Welsh
authors.forename: Monica
authors.initials: M
authors.lastname: Halem
mesh_terms: D000335:Aerosol Propellants / Q000627:therapeutic use*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D006225:Hand; D006801:Humans; D006846:Hydrocarbons, Halogenated / Q000627:therapeutic use*; D006945:Hyperhidrosis / Q000188:drug therapy*; D007036:Hypothermia, Induced / Q000379:methods*; D007267:Injections / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000335:Aerosol Propellants; D006846:Hydrocarbons, Halogenated; D019274:Botulinum Toxins, Type A