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Botulinum toxin in the treatment of sweat-worsened foot problems in patients with epidermolysis bullosa simplex and pachyonychia congenita.
[epidermolysis bullosa simplex]
Painful
foot
blistering
is
a
common
problem
in
patients
with
epidermolysis
bullosa
simplex
(
EBS
)
and
pachyonychia
congenita
(
PC
)
.
Hyperhidrosis
,
a
condition
which
can
be
effectively
blocked
by
plantar
injections
of
botulinum
toxin
(
Btx
)
,
often
exacerbates
the
blistering
.
A
retrospective
evaluation
of
the
effects
of
Btx
injections
in
14
patients
with
EBS
and
PC
with
foot
blisters
and
painful
callosities
.
After
informed
consent
,
patients
with
EBS
(
n
=
6
)
and
PC
(
n
=
8
)
,
aged
7
-
66
years
,
who
had
received
Btx
therapy
at
our
centre
since
2003
,
were
included
.
The
treatment
consisted
of
multiple
plantar
injections
of
Btx
A
or
Btx
B
after
prior
regional
or
general
anaesthesia
.
Patients
were
interviewed
about
the
treatment
effect
and
were
asked
to
score
the
improvement
from
0
to
5
,
where
5
is
'
excellent
'
.
One
patient
with
PC
with
painful
callosities
was
studied
by
magnetic
resonance
(
MR
)
spectroscopic
microimaging
before
and
after
Btx
injections
to
disclose
any
underlying
blisters
.
In
total
,
76
treatments
were
evaluated
(
one
to
19
sessions
per
patient
)
.
Thirteen
patients
(
93
%
)
reported
reduced
plantar
blistering
and
pain
;
the
improvement
score
was
≥
4
in
four
of
six
patients
with
EBS
and
six
of
eight
patients
with
PC
.
The
mean
effect
duration
was
3
months
.
No
adverse
events
,
apart
from
mild
anticholinergic
side-effects
in
two
patients
,
were
noted
.
MR
spectroscopic
microimaging
showed
disappearance
of
intraepidermal
blistering
after
Btx
therapy
.
Plantar
injection
of
Btx
is
an
efficient
,
long
-lasting
and
safe
treatment
of
painful
blistering
and
callosities
in
EBS
and
PC
that
can
be
given
repeatedly
without
loss
of
efficacy
.
Diseases
Validation
Diseases presenting
"a condition which can be effectively blocked by plantar injections of botulinum toxin"
symptom
epidermolysis bullosa simplex
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