Botulinum toxin for treatment of craniofacial hyperhidrosis

The effect of botulinum toxin A (BTX) was studied on 12 patients with idiop athic craniofacial hyperhidrosis. After confirming the diagnosis by Minor's iodine starch test we first treated one-half of the forehead with an injec tion of 2.5-4 ng BTX (Dysport) equidistantly intracutaneously. After 4 week s we assessed the efficacy by another Minor's iodine starch test and then t reated the other half. Another 4 weeks later a standardized telephone inter view was carried out. After 1-7 days the craniofacial sweating in the area injected had completely ceased in 11 patients and was mildly reduced in the remaining one. The efficacy was confirmed by repeated Minor's iodine starc h tests. Mild weakness of frowning was the only side effect, lasting 1-12 w eeks and completely resolving in all patients. Although sweating has not ye t recurred in most patients at follow-up periods up to 27 months, one patie nt had a relapse 9 months after treatment. Following reports on palmar and axillary hyperhidrosis and gustatory sweating (Frey's syndrome) this is app arently the first report on the use of BTX in the treatment of idiopathic c raniofacial hyperhidrosis. BTX seems a promising new treatment for localize d hyperhidrosis.