Treating childhood hyperhidrosis with botulinum toxin type A
- 1Rheumatology and Rehabilitation Research Unit, School of Medicine, University of Leeds, 36 Clarendon Road, Leeds LS2 9NZ, UK;
- 2Consultant in Paediatric Neurology, St James's University Hospital, Leeds, UK
Recently there have been a number of published studies on the use of botulinum toxin type A for hyperhidrosis.1,2 These studies focus on its use in adults and we would like to highlight that it can also be useful in treating childhood hyperhidrosis. As in adults, hyperhidrosis can have considerable impact on quality of life in children. This is illustrated by a 13 year old healthy girl referred for treatment of refractory hyperhidrosis. Excessive palmar sweating caused difficulty with school work (difficulty holding a pen, with the ink smudging the paper because of sweating) and social embarrassment. Botulinum toxin type A (Dysport; 20 mouse units) was administered intradermally using a 27G needle to the finger tips and the area over the hypothenar and thenar eminences of both hands. EMLA cream was used for topical anaesthesia. She reported sufficient reduction in palmar sweating within one week to improve her school work. She noticed grip strength reduction that lasted three weeks but did not affect hand function significantly. The beneficial effect of botulinum toxin lasted four months after which she requested further treatment. Repeat injections were given to the fingertips only. No adverse effect on grip strength was reported despite some functional benefit from reduced sweating. To date she has had four courses of treatment over a period of two years with good effect.
Although treatments such as aluminium hydroxide and iontophoresis can be effective and may be preferred in children, we suggest that botulinum toxin should be considered for children with refractory hyperhidrosis who do not want surgery.3