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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
"pain"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
adrenomyeloneuropathy
aniridia
aromatase deficiency
carcinoma of the gallbladder
cholangiocarcinoma
coats disease
congenital diaphragmatic hernia
congenital toxoplasmosis
cushing syndrome
cutaneous mastocytosis
cystinuria
dedifferentiated liposarcoma
dentin dysplasia
dracunculiasis
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
erdheim-chester disease
erythropoietic protoporphyria
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
fabry disease
familial mediterranean fever
focal myositis
hirschsprung disease
hodgkin lymphoma, classical
holt-oram syndrome
junctional epidermolysis bullosa
kabuki syndrome
kindler syndrome
lamellar ichthyosis
liposarcoma
locked-in syndrome
lymphangioleiomyomatosis
malignant atrophic papulosis
neuralgic amyotrophy
oligodontia
oral submucous fibrosis
papillon-lefèvre syndrome
phenylketonuria
pleomorphic liposarcoma
primary hyperoxaluria type 1
proteus syndrome
pyomyositis
scrub typhus
sneddon syndrome
systemic capillary leak syndrome
thoracic outlet syndrome
trochlear dysplasia
typhoid
von hippel-lindau disease
waldenström macroglobulinemia
well-differentiated liposarcoma
wolf-hirschhorn syndrome
This symptom has already been validated