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Duration and Efficacy of Botox for the Treatment of Hyperhidrosis in Upper Extremity Amputees
Jordan E Nus, BS
1; Erin L Weber, MD, PhD
2(1)Indiana University School of Medicine, Indianapolis, IN, (2)Indiana University, Indianapolis, IN
IntroductionHyperhidrosis can cause embarrassment, anxiety, skin maceration, and increased risk of infection. But in amputees, hyperhidrosis can have serious functional consequences, causing slippage of prosthetics, limb malfunction, and increased risk of injury to self or others. Botulinum toxin, studied primarily in lower extremity amputees, successfully reduces sweat production and improves prosthetic use. Few studies have evaluated the effect of Botox on upper extremity prosthetic use. In this study, we sought to define the duration of Botox effect in upper extremity amputees with prosthetic dysfunction caused by hyperhidrosis.
Materials and MethodsWe conducted a retrospective chart review of five upper extremity amputees receiving Botox injection for hyperhidrosis of the residual limb. Data collected included age, sex, amputation level and laterality, time from amputation to injections, time between injections, Botox units administered per session, and duration of symptom relief between each injection. 2 units of Botox was injected intradermally in a 2x2 cm grid pattern over the area of residual limb covered by the prosthetic, as well as 2 cm proximal to the prosthetic. Duration of effect was determined by the patient's subjective experience and recurrence of their symptoms.
ResultsFive male patients were included in this study, with an average age of 44 (range: 31-68). Three patients had bilateral amputations while two had unilateral amputations, for a total of five transradial and three transhumeral amputations. The average time from amputation to first injection was 23.4 ± 9.7 months. The average Botox dose was 236 units (range: 160-400) per limb. Patients received between 3-6 separate injection sessions per limb over time. All patients reported reduced sweating and improved prosthetic function following injections. The average duration of effect was 5.3 ± 2.5 months. Three patients reported minimal variation in effect between sessions (3-6 months), while two other patients oscillated between 4-8 months and 4-13 months of treatment effectiveness. There were no adverse effects reported during or after treatment.
ConclusionsBotulinum toxin is an effective treatment for reducing hyperhidrosis and improving prosthetic use in upper extremity amputees. In this study, treatment provided an average of 5 months of symptom relief; Our findings support Botox as an efficacious, but temporary, intervention for upper extremity amputees with prosthetic malfunctions due to hyperhidrosis. More studies with a larger patient population are necessary to assess optimal dosing and long-term outcomes.
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