Hyperhidrosis is a condition characterized by excessive sweating and is a socially significant medical problem. According to different authors, the prevalence of primary hyperhidrosis among the population ranges from 3 to 15%. From 1 to 5% of people suffer from severe forms of hyperhidrosis, among which the majority are young.
One of the important conditions for the successful treatment of idiopathic hyperhidrosis of any localization is the development of a phased plan for the procedures, in which local methods, including botulinum toxin injections, are a priority. Surgical treatment and systemic drugs should be used in cases of failure of local methods of correction. When choosing the type of treatment, it is also recommended to take into account the localization of hyperhidrosis. So, for example, with axillary hyperhidrosis, the use of aluminum chlorhydroxide and surgical removal of the sweat glands are effective; with palmar-plantar hyperhidrosis - iontophoresis and sympathectomy of the thoracic ganglia. Botulinum toxin (BTA) can be successfully used to treat both axillary and palmoplantar hyperhidrosis.
CLINICAL CASE
Patient K., 27 years old, came to the clinic, suffering from plantar and axillary hyperhidrosis for 5 years. At the time of the examination, she complained of increased sweating, an unpleasant smell of sweat, a state of psychological and physical discomfort. The patient did not receive any treatment for plantar hyperhidrosis. During the collection of anamnesis, no contraindications to BTA therapy were identified.
After signing the informed consent, 80 units of Botox were administered in the first stage of treatment. At the second stage of treatment, after 2 months, plantar hyperhidrosis was corrected. The area and intensity of plantar hyperhidrosis were determined bilaterally using a starch iodine test (Minor's test). Based on the combination of the area of hyperhidrosis and the intensity of starch staining, hyperhidrosis was regarded as moderately pronounced.
Regional anesthesia of the foot. To anesthetize the injection of Botox into the sole area, a blockade of the tibial (p. tibialis) and gastrocnemius (p. suralis) nerves was performed. Sol was used as an anesthetic. Lidocaini 2%, which was reconstituted with 0.9% sodium chloride solution (saline) to a concentration of 1%. The total volume of anesthetic for one sole was 6-10 ml. The lidocaine solution was injected using a 22G needle (0.7 x 40 mm).
In tibial nerve block, the medial malleolus and posterior tibial artery (a. tibialis posterior) were used as anatomical landmarks. After palpation a. tibialis posterior, the needle was directed tangentially to the pulsation point until a sensation of paresthesia was obtained or until contact with the bone. In case of paresthesia, the needle was withdrawn by 1-2 mm and 3-5 ml of anesthetic solution was injected.
For sural nerve blockade, the lateral malleolus and Achilles tendon served as anatomical landmarks. Blockade was performed by deep subcutaneous fan-shaped infiltration of 3-5 ml of lidocaine solution between the lateral malleolus and the Achilles tendon.
Within 10 minutes, the development of a complete blockade of pain sensitivity was noted; within 10 minutes, the development of a complete blockade of pain sensitivity in the region of both feet was noted without the appearance of any undesirable reactions.
Botox injection method. 100 units of Botox were diluted in 2 ml of 0.9% sodium chloride solution to a concentration of 50 units/ml. For injections, a U-40 insulin syringe with a volume of 1 ml, a 29G needle (0.33 x 12.7 mm) was used. Injections were performed intradermally at 20 points on each foot, 2.5 units of Botox were injected into each point, the interval between injection points was 1.5–2 cm. The total dose of Botox per foot was 50 units. When performing injections, no adverse events were noted.
Treatment results. The patient noted the beginning of the anhydrotic action of BTA on the 7th day after treatment. At the visit to the doctor 2 weeks after the Botox injections, the patient did not complain about increased sweating in the feet and was satisfied with the effectiveness of the treatment. The bilateral Minor test showed a negative result. There were no signs of compensatory hyperhidrosis or other adverse events.
Five months after the injections, the patient also did not complain of increased sweating in the area of the feet and was still satisfied with the result of the treatment. According to the Minor test, only single, insignificant areas of starch staining were detected, which confirmed the preservation of the anhydrotic effect of Botox injections. There were no signs of compensatory hyperhidrosis or other adverse events.
Conclusion
When correcting plantar hyperhidrosis with Botox (100 IU) under regional anesthesia, a pronounced positive result was achieved, which was confirmed by both subjective (no complaints from the patient) and objective (negative Minor test) assessments. The effect of the introduction of Botox appeared after 7 days and lasted more than 5 months.
SUMMARY
Treatment of plantar hyperhidrosis with botulinum toxin injection has a number of clear advantages, such as high efficacy, safety, absence of compensatory hyperhidrosis, ease and possibility of performing the procedure on an outpatient basis, as well as a high degree of patient satisfaction with the results. The use of Botox for the treatment of plantar hyperhidrosis leads to a stable clinical result.
According to medtriumf.ru
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