Botulinum toxin B in the treatment of craniofacial hyperhidrosis.

BACKGROUND: Hyperhidrosis affects up to 3% of the population and negatively affects patients' quality of life. Craniofacial hyperhidrosis is a common complaint which has been successfully treated with botulinum toxin B (Btx B) since 2004 at our hidrosis clinics.

OBJECTIVE: To evaluate the safety and clinical effect of Btx B in craniofacial hyperhidrosis.

METHODS: The dermatology life quality index (DLQI) was monitored before and after treatment in 38 patients with craniofacial hyperhidrosis. Sweating before and after treatment was monitored by measuring trans epidermal water loss and by collecting gravimetric data. Global Assessment of Therapy in a 5-grade scale was captured.

RESULTS: DLQI scores were significantly improved at follow-up 2-4 weeks posttreatment and sweating was significantly reduced. DLQI scores before treatment were 13 ± 1 (mean ± SD) and posttreatment 5 ± 1 which was highly statistically significant (P < 0.001). Sweating before treatment monitored with trans epidermal water loss was 52 ± 31 g/m(2) /h which decreased to 18 ± 7 g/m(2) /h (P < 0.001) posttreatment. Gravimetric data yielded a sweat rate of 0.07 ± 0.08 mg/min at baseline, which consequently dropped to 0.02 ± 0.05 mg/min (P < 0.05) posttreatment. Regarding the Global Assessment of Therapy 87% of the patients were satisfied (score 4-5) with the treatment result. In a 2-year follow-up, 74% returned for further treatments after a median time of 5 months. Side-effects were mild and most commonly reported was stiffness of the forehead and the eyebrows.

CONCLUSIONS: In this prospective, uncontrolled study Btx B seems to be both a safe and effective treatment in craniofacial hyperhidrosis improving quality of life and reducing extreme sweating.