title: Topical botulinum toxin to treat hyperhidrosis? No sweat!
abstract: Palmar, plantar and axillary hyperhidrosis, though benign, may be burdensome and occupationally restrictive, even hazardous. Treatment modalities range from topical antiperspirants, iontophoresis, systemic medications such as anticholinergics and benzodiazepines and injections of botulinum toxin, to thoracic sympathectomy. Intradermal injections of botulinum toxin (BTX), though effective, are painful especially when multiple injections are required. Iontophoretic administration of BTX has been described, the BTX entering the eccrine sweat glands via the sweat pores and through the sweat ducts. We postulate that BTX can be administered topically, either unassisted or assisted by application of an electrical gradient, low-frequency ultrasound or excipients such as dimethylsulfoxide. We examine the rationale and feasibility for such a treatment modality and route of administration.
authors.affiliation: Division of Neurology, Yong Loo Lin School of Medicine, National University of Singapore/National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. erlelim@nus.edu.sg
authors.forename: Erle C H
authors.initials: EC
authors.lastname: Lim
authors.forename: Raymond C S
authors.initials: RC
authors.lastname: Seet
authors.forename: Adeline
authors.initials: A
authors.lastname: Chow
authors.forename: Vernon M S
authors.initials: VM
authors.lastname: Oh
authors.forename: Benjamin K C
authors.initials: BK
authors.lastname: Ong
authors.forename: Einar P V
authors.initials: EP
authors.lastname: Wilder-Smith
mesh_terms: D000287:Administration, Topical; D000328:Adult; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006945:Hyperhidrosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D008962:Models, Theoretical; D009465:Neuromuscular Agents / Q000008:administration & dosage; D010146:Pain; D013546:Sweating; D009435:Synaptic Transmission
chemical_list: D009465:Neuromuscular Agents; D001905:Botulinum Toxins