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Br J Dermatol. 2010 Nov;163(5):1072-6. doi: 10.1111/j.1365-2133.2010.09927.x.

Botulinum toxin in the treatment of sweat-worsened foot problems in patients with epidermolysis bullosa simplex and pachyonychia congenita.

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  • 1Department of Dermatology, County Council of Gävleborg, Uppsala University, University Hospital, SE-751 85 Uppsala, Sweden. Carl.swartling@sophiahemmet.se

Abstract

BACKGROUND:

Painful foot blistering is a common problem in patients with epidermolysis bullosa simplex (EBS) and pachyonychia congenita (PC). Hyperhidrosis, a condition which can be effectively blocked by plantar injections of botulinum toxin (Btx), often exacerbates the blistering.

OBJECTIVES:

A retrospective evaluation of the effects of Btx injections in 14 patients with EBS and PC with foot blisters and painful callosities.

METHODS:

After informed consent, patients with EBS (n = 6) and PC (n = 8), aged 7-66 years, who had received Btx therapy at our centre since 2003, were included. The treatment consisted of multiple plantar injections of Btx A or Btx B after prior regional or general anaesthesia. Patients were interviewed about the treatment effect and were asked to score the improvement from 0 to 5, where 5 is 'excellent'. One patient with PC with painful callosities was studied by magnetic resonance (MR) spectroscopic microimaging before and after Btx injections to disclose any underlying blisters.

RESULTS:

In total, 76 treatments were evaluated (one to 19 sessions per patient). Thirteen patients (93%) reported reduced plantar blistering and pain; the improvement score was ≥ 4 in four of six patients with EBS and six of eight patients with PC. The mean effect duration was 3 months. No adverse events, apart from mild anticholinergic side-effects in two patients, were noted. MR spectroscopic microimaging showed disappearance of intraepidermal blistering after Btx therapy.

CONCLUSIONS:

Plantar injection of Btx is an efficient, long-lasting and safe treatment of painful blistering and callosities in EBS and PC that can be given repeatedly without loss of efficacy.

© 2010 The Authors. BJD © 2010 British Association of Dermatologists.

[PubMed - indexed for MEDLINE]
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