Botulinum toxin
onaA, aboA or incoA shown to have similar efficacy/safety
Doses below for onaA
- Axillary: 50-100 units/axilla (10–20 injection sites spaced 1.5–2 cm apart)
- Palmar: 50-200 units/palm (among 50–100 injection sites)
- Plantar: 50-200 units/sole
- Forehead/scalp: 50-100 units
- Frequency of injections: every 4-6 months
Inhibition at neuromuscular junction: cleaves SNARE proteins blocking pre-synaptic acetylcholine release leading to reduction in sweat
Absolute
- Allergy
- Skin infection
Relative
- Pregnancy/lactation
- Peripheral motor neuropathic diseases
- Anaphylaxis (rare)
- Pain, swelling, erythema, bruising, headache
- Weakness of underlying muscles (e.g. hand weakness, brow/lip ptosis, etc.); typically, resolves
- Exacerbation of neuromuscular disease
Increased effects if given with drugs that interfere with neuromuscular transmission
- Aminoglycosides
- Muscle relaxants
- Onset within 4-10 days
- Lasts 5-9 months
- Used for palmoplantar, forehead and axillary hyperhidrosis
- Starch-iodine testing pre-operatively to localize sites involved
- Pregnancy category C