Axillary injection of botulinum A toxin in a patient with muscle cramps associated with severe axillary hyperhidrosis

Muscle cramps may be caused by fluid and salt loss induced by diffuse or fo cal hyperhidrosis. Recent reports have described the efficacy of botulinum toxin in the treatment of primary focal hyperhidrosis. Botulinum toxin inhi bits sweating by blocking exocytosis of acetylcholine from presynaptic chol inergic nerve terminals. We report the case of a patient who complained of frequent muscle cramps as sociated with unusually severe axillary hyperhidrosis. We used botulinum to xin to treat the excessive focal sweating presuming that it would also redu ce the muscle cramps. A total dose of 200 MU of botulinum A toxin (Dysport) per axilla markedly reduced sweating and cramps. The beneficial effect sta rted four days after the injection and it was still present five months lat er. Treatment was repeated in the sixth month with analogous results. No si de-effects were observed and no compensatory sweating occurred.