title: Skin cooling for botulinum toxin A injection in patients with focal axillary hyperhidrosis: a prospective, randomized, controlled study.
abstract: BACKGROUND
  Botulinum toxin A (BTX-A) injections are a commonly used and effective therapy for patients with focal axillary hyperhidrosis. However, injections are often painful. Therefore, we studied whether skin cooling decreases pain during injection.
  
  
  METHODS
  Thirty-one patients (n = 31) with focal axillary hyperhidrosis were enrolled in the present study. Patients were treated with 50 MU BTX-A (Botox; Allergan, Irvine, CA) in each axilla. One group (n = 21) received a skin cooling using a cold-air system (SmartCool; Cynosure, Westford, MA) versus no cooling on the other side. In the second group (n = 10), patients were cooled with the same cold air blower on one axilla and ice cubes on the other. For evaluation of the effect of cooling in both groups, relative pain scores using a visual analog scale (VAS) were recorded.
  
  
  RESULTS
  In the first group, the air-cooled-side pain scores ranged from 0 to 4 (average: 2.5) versus 5 to 10 (average: 7.4) on the noncooled side. The air-cooled side showed a 66.2% higher reduction in pain score. In the second group, no significant difference was seen between air and ice cooling (average pain score 2.0 versus 2.4; P > 0.05).
  
  
  CONCLUSIONS
  Skin cooling decreases pain during injection of BTX-A in patients with focal axillary hyperhidrosis, with ice and air cooling showing the same efficacy.
authors.affiliation: Department of Dermatology and Allergology, Ruhr-University Bochum, Bochum, Germany. f.bechara@elis-stiftung.de
authors.forename: Falk G
authors.initials: FG
authors.lastname: Bechara
authors.forename: Michael
authors.initials: M
authors.lastname: Sand
authors.forename: Peter
authors.initials: P
authors.lastname: Altmeyer
authors.forename: Daniel
authors.initials: D
authors.lastname: Sand
authors.forename: Klaus
authors.initials: K
authors.lastname: Hoffmann
mesh_terms: D000293:Adolescent; D000328:Adult; D001365:Axilla; D001831:Body Temperature; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D004867:Equipment Design; D005260:Female; D006801:Humans; D006945:Hyperhidrosis / Q000188:drug therapy* / Q000503:physiopathology*; D007036:Hypothermia, Induced / Q000295:instrumentation*; D007279:Injections, Subcutaneous; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D012867:Skin
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A