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Botulinum toxin improves quality of life in hidradenitis suppurativa

Key clinical point: Intradermal injections with botulinum toxin type B (BTX-B) improve quality of life and self-assessed symptoms in patients with hidradenitis suppurativa (HS).

Major finding: Dermatology Life Quality Index scores improved from a median of 17 to 8 after 3 months in the BTX-B group compared with an improvement from 13.5 to 11 in the placebo group (P less than .05). Patient’s own rating of HS-related impairment of general health on the visual analog scale improved from a baseline median of 8.0 to 3.5 in the BTX-B group compared with a median of 6.0 to 5.5 in the placebo group (P less than .05). 55% of patients reported some degree of hyperhidrosis.

Study details: This single-center, randomized, double-blind trial included 20 patients with HS stage I-III disease for injections with either a placebo (saline) or BTX-B.

Disclosures: The study was funded by the University Hospital of North Norway and the University Hospital in Uppsala, Sweden. Carl Swartling is a shareholder in Hidros International and is the owner of sweat clinics in Stockholm and Oslo. Øystein Grimstad and Bjørn Øivind Kvammen reported no conflicts of interest.

Commentary

“Individual case reports have reported improvement in hidradenitis suppurativa symptoms following injection of botulinum toxin into affected areas. In this randomized, blinded, placebo-controlled study of 20 patients, those receiving botulinum toxin injections had statistically significant improvement in Dermatology Life Quality Index (DLQI) scores, as well as visual analog scale of HS-related health impairment. HS lesion count decreased significantly from baseline following injection. Most patients were classified as having Hurley stage I disease, followed by Hurley stage II. About half of patients had hyperhidrosis at baseline, but the authors did not report whether these patients were more or less likely to report improvement in DLQI or HS-related symptoms.

These results suggest botulinum toxin injection may be a useful adjunctive therapy for mild-to-moderate hidradenitis. However, the mechanism by which it is efficacious (e.g., by improving symptoms related to excessive sweating or by altering the cutaneous microbiome, or by other methods) is unclear. A recently published prospective study of 5 patients showed a similar quality-of-life improvement in those receiving botulinum toxin. Together, these studies suggest botulinum toxin injection is an intervention deserving of further study for treatment of HS and HS-related symptoms.”

Robert G. Micheletti, MD

Assistant Professor of Dermatology and Medicine

Perelman School of Medicine, University of Pennsylvania

Reference:
Hua VJ, Kuo KY, Cho HG, Sarin KY. Hyperhidrosis affects quality of life in hidradenitis suppurativa: a prospective analysis. J Am Acad Dermatol. 2020;82(3):753–64.

Citation:

Grimstad Ø et al. Am J Clin Dermatol. 2020 Aug 6. doi: 10.1007/s40257-020-00537-9.