 The
chief problem
encountered with the
treatment of hands
and feet by Botox®
injections is the
intense pain
associated with the
needle puncture into
the densely
innervated skin of
these regions. The
traditional
technique is to
perform a nerve
block on the wrist
or ankle before the
injections to avoid
the pain. The
potential
complications of a
nerve block are
nerve or vessel
damage and temporary
loss of hand
dexterity. For this
reason, many
physicians who
contentedly treat
axillary
hyperhidrosis,
refuse to treat
palmar and plantar
hyperhidrosis with
Botox®.
The needle free
anesthesia delivers
almost painlessly* a
tiny amount of
anesthetic 0.02 to
0.03 mL through a
needle free device (the
MED-JET manufactured
by MIT Canada)
which provides total
analgesia prior to
Botox® injections
with needles
Benohanian A.
Needle-free
anesthesia: a
promising technique
for the treatment of
palmoplantar
hyperhidrosis with
botulinum toxin A.
Therapy (2006) 3 (5)
591-596
*
average score pain 2
on a scale of 0 to
10 where 0 indicates
no pain and 10
indicates the worst
possible pain.
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 After injecting
close to a hundred
patients with needle
free anesthesia
prior to injection
of Botox® with
needles for palmar
and plantar
hyperhidrosis, I
came to the
conclusion that the
minimal required
dose of Botox® is
100 units per palm
and 150 units per
sole. Although the
expected remission
period ranges
between 4 and 12
months, two of my
treated patients
exceeded 18 months.
Also, a temporary
muscle weakness
following the
injections may occur
in less than 20% of
the patients and may
last an average of 3
weeks. The success
rate with this
method, alone or
combined with
supersaturated
concentrations of
aluminum chloride
(40 to 55%) in a
salicylic acid gel
are about 75 % for
the hands and 60%
for the feet. The
use of this topical
preparation may help
to keep the Botox®
injections volumes
low and stretch
their injection
interval thus
avoiding the
potential risk of
neutralizing
antibody formation.
These two features
together, would
reduce the risk of
neutralizing
antibody formation
which renders the
Botox injections
totally ineffective.
[ Dressler D. High
doses of Botox and /
or shorter intervals
between treatment
sessions may
generate antibodies
to Botulinum toxin
which renders the
Botox injections
totally
ineffective..
(Pharmacological
aspects of
therapeutic
botulinum toxin
preparations )
Nervenarzt. 2006
Aug;77(8):912-921
].
Most of insurance
companies cover this
form of therapy when
topical preparations
containing aluminum
chloride fail to
control the
condition or are not
tolerated by the
patient. For further
details see
www.sweatmanagement.ca. |
