Botulinum toxin type-A for the treatment of inverse psoriasis.
OBJECTIVE
To evaluate the efficacy of botulinum toxin type-A (BoNTA) for the treatment of inverse psoriasis.


BACKGROUND
The use of BoNTA in inverse psoriasis would be a novel approach compared with conventional treatments and may act at the neuroglandular junction level to reduce local sweating with its consequent skin maceration and secondary infection and at the extra-junction level to inhibit the liberation of neuropeptides and other pro-algogenic substances responsible for inflammation, hyperkeratosis and pain transmission.


METHODS
Fifteen patients with a confirmed diagnosis of inverse psoriasis were enrolled into the study. The psoriasis was located in several areas: armpits (7 patients), submammary sulcus (6 patients), intergluteal folds (7 patients), inguinal folds (5 patients) and umbilicus (1 patient).


METHODS
BoNTA treatment comprised individual injections 2.8 cm apart of 2.4 U BoNTA, with a total dosage between 50 and 100 U per patient depending on the extent and severity of the psoriasis. Patient assessments were done pre-treatment and at 2, 4 and 12 weeks post-treatment. The erythematous area was defined using objective photographic evidence, and subjective patient assessment of pain and itch was assessed using a 10-point visual analogue scale scale.


RESULTS
Subjective symptomatology improved in all patients and erythema extension, intensity and infiltration improved in 13 of 15 patients (87%). Treatment was well tolerated with no reported adverse events.


CONCLUSIONS
BoNTA therapy resulted in improvements in subjective patient symptomatology and objective reductions in erythema and maceration in the treated areas according to photographic evidence. Further large-scale methodologically rigorous studies are required to investigate the safety and efficacy of BoNTA in this indication.
Zanchi
M
M
Department of Dermatology, SS Giovanni E Paolo Civil Hospital, Venice, Italy. malvina_zanchi@yahoo.it
Favot
F
F
Bizzarini
M
M
Piai
M
M
Donini
M
M
Sedona
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011565:Psoriasis / Q000188:drug therapy*; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A