Hyperhidrosis and Botulinum Toxin in Dermatology

Transcription

1 Hyperhidrosis and Botulinum Toxin in Dermatology

2 Current Problems in Dermatology Vol. 30 Series Editor G. Burg Zurich

3 Hyperhidrosis and Botulinum Toxin in Dermatology Volume Editors O.P. Kreyden Zurich/Muttenz R. Böni Zurich G. Burg Zurich 62 figures, 40 in color, and 18 tables, 2002 Basel Freiburg Paris London New York New Delhi Bangkok Singapore Tokyo Sydney

4 O.P. Kreyden R. Böni Dermatology and Venereology FMH Department of Dermatology Praxis Methininserhof University Hospital of Zurich Baselstrasse 9 Gloriastrasse 31 CH 4132 Muttenz (Switzerland) CH 8091 Zurich (Switzerland) praxis@kreyden.ch G. Burg Department of Dermatology University Hospital of Zurich Gloriastrasse 31 CH 8091 Zurich (Switzerland) Library of Congress Cataloging-in-Publication Data Hyperhidrosis and botulinum toxin in dermatology / volume editors, O.P. Kreyden, R. Böni, G. Burg. p. ; cm. (Current problems in dermatology ; v. 30) Includes bibliographical references and index. ISBN (hard cover : alk. paper) 1. Hyperhidrosis Treatment. 2. Botulinum toxin Therapeutic use. I. Kreyden, O.P. (Oliver Philip) II. Böni, R. (Roland) III. Burg, Günter. IV. Series. [DNLM: 1. Botulinum Toxins therapeutic use. 2. Hyperhidrosis drug therapy. WR 400 H ] RL141.H dc Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents and Index Medicus. Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Copyright 2002 by S. Karger AG, P.O. Box, CH 4009 Basel (Switzerland) Printed in Switzerland on acid-free paper by Reinhardt Druck, Basel ISSN ISBN

5 Contents VIII Editors portraits X Acknowledgment XI Preface Burg, G. (Zurich) Anatomy of Sweat Glands and Pathophysiology of Sweating 3 Anatomy of Sweat Glands Groscurth, E. (Zurich) 30 Pathophysiology of Sweating Hölzle, E. (Oldenburg) 23 Good and Bad Body Odours Wedekind, C. (Edinburgh) Traditional Treatment of Hyperhidrosis 30 Topical Pharmacological Treatment Hölzle, E. (Oldenburg) 44 Generalized Hyperhidrosis and Its Systemic Treatment Böni, R. (Zurich) 48 Tap Water Iontophoresis Anliker, M.D. (Aarau); Kreyden, O.P. (Zurich)

6 Surgical Intervention in Hyperhidrosis 57 Axillary Sweat Gland Excision Hafner, J.; Beer, G.M. (Zurich) 64 Thoracic Sympathectomy Kestenholz, P.B.; Weder, W. (Zurich) History of Botulinum Toxin 77 The History of Botulism Geiges, M.L. (Zurich) 94 Botulinum Toxin: From Poison to Pharmaceutical. The History of a Poison That Became Useful to Mankind Kreyden, O.P. (Zurich) 303 Botulinum Toxin in Warfare Böni, R. (Zurich) Basic Aspects of Botulinum Toxin 307 Physiology and Pharmacology of Therapeutic Botulinum Neurotoxins Aoki, K.R. (Irvine, Calif.) 337 Botulinum Neurotoxins Are Metalloproteases Specific for SNARE Proteins Involved in Neuroexocytosis Rossetto, O., Seveso, M., Caccin, P., Montecucco, C. (Padova) 326 Storage and Dilution of Botulinum Toxin Klein, A.W. (Beverly Hills, Calif.), Kreyden, O.P. (Muttenz) 333 Dose-Dependent Anhidrotic Effect of Botulinum Toxin Erbguth, F.J. (Erlangen) 343 Complications and Side-Effects of Botulinum Toxin A Schaffner, R., Kreyden, O.P. (Zurich) Botulinum Toxin in the Treatment of Hyperhidrosis 349 Hyperhidrosis of the Axilla Heckmann, M. (Munich) 356 Hyperhidrosis of the Palms and Soles Moraru, E., Auff, E., Schnider, P. (Vienna) 370 Frey s Syndrome.Treatment with Botulinum Toxin Laskawi, R., Rohrbach, S. (Göttingen) 378 Rare Forms of Hyperhidrosis Kreyden, O.P. (Zurich) Contents VI

7 Other Indications of Botulinum Toxin 388 Treatment of Wrinkles with Botox Klein, A.W. (Beverly Hills, Calif.) 238 Botulinum Toxin and Anal Fissure Stein, E. (Limburgerhof) 227 Botulinum Toxin and the Eye Huber, A. (Zurich) 236 Botulinum Toxin A and the Face Reichel, G. (Zwickau) 246 Author Index 247 Subject Index Contents VII

8 Editors Portraits Oliver Philip Kreyden, MD Praxis Methininserhof, Muttenz, Switzerland Former Head of Hyperhidrosis Unit, University Hospital of Zurich, Switzerland Medical studies and residency in Basel and Zurich. Board-certified dermatologist and venereologist. Ancient resident at the Department of Dermatology, University Hospital of Zurich. In 1998, establishment of the first hyperhidrosis unit at the Dermatology Department of the University Hospital in Zurich. In 2000, organisation and executive of the first Swiss Congress of botulinum toxin in the treatment of hyperhidrosis. Performance of European Injection Technique Training Courses. Chairman at hyperhidrosis course on the occasion of the EADV. Several publications and international lectures in the field of botulinum toxin and hyperhidrosis. Member of the Swiss Society of Dermatology and Venereology (SGDV), German Society of Dermatology (DDG), European Academy of Dermatology and Venereology (EADV), European Society of Cosmetic and Aesthetic Dermatology (ESCAD), American Academy of Dermatology (AAD). In autumn 2001 opening of a private practice for Dermatology and Venereology in Muttenz near Basel, Switzerland. VIII

9 R. Böni, MD Zurich Roland Böni studied Medicine at the University of Zurich. During his research career he worked at the Rockefeller Institute in New York, the Case Western Reserve University in Cleveland and at the National Institutes of Health, National Cancer Institutes in Maryland. Since 1997 Roland Böni has focused his research on the genetic analysis of microdissected tumors. Roland Böni has founded a biotech company in 2001, GRL Inc., and has currently a position as a senior physician at the University Hospital of Zurich. G. Burg, MD Zurich Since 1991, Dr. Günter Burg has been Chairman of the Department of Dermatology, University School of Medicine, Zurich, Switzerland, and is currently also the Dean of the Medical Faculty. He was the Chairman of the Department of Dermatology, University School of Medicine in Würzburg, Germany, from 1988 to Dr. Burg is member or honorary member of over 30 dermatological, medical and scientific societies and associations. Besides general dermatology and dermatopathology, his major research fields are cutaneous lymphoma and malignant melanoma and he has published more than 300 papers in peer-reviewed journals. Editors Portraits IX

10 Acknowledgment We greatly acknowledge Mr. Hans Martin Brütsch, Project Manager, Botox (Allergan, Lachen, Switzerland) and Caroline Collins (Allergan Europe) for the generous financial support of this volume. X

11 Preface Hyperhidrosis and bromhidrosis both have a high psychosocial impact on those who suffer from these types of functional dysregulation of the sweat glands. Many treatment modalities have been tried, most with little success. Recently, there has been an increased interest in these disorders, due to the introduction of botulinum toxin into medicine as a modality for treating not only muscle disorders, but also hyperhidrosis. Botulinum toxin is a neurotoxin of the anaerobic bacterium Clostridium botulinum, which specifically blocks the liberation of acetylcholine in motor and vegetative nerve ends. Hyperhidrosis is not only an unpleasant personal stigma, but also increases the risk of acquiring delayed-type hypersensitivity, especially in occupations which are prone to the development of epicutaneous sensitization. Botulinum toxin gives new perspectives to these patients. At the same time, botulinum toxin is an extremely potent poison, which requires exceptional care and responsibility on the part of the treating physician in order to be safely used for treatment purposes. This book describes the state of the art in our knowledge of hyperhidrosis and its treatment. It begins with the anatomy of the sweat glands and the pathophysiology of sweating, and reviews the traditional and surgical treatment modalities of hyperhidrosis. Most chapters, however, are devoted to the use of botulinum toxin. Following a review of historical and basic aspects, it offers valuable applied knowledge in the form of a summary of our current clinical experience and detailed instructions in the practical application of botulinum toxin for the treatment of hyperhidrosis. Side effects and complications are also thoroughly discussed. Most of the authors contributing to this book have long personal experience in the practical use of botulinum toxin for the treatment of hyperhidrosis and XI

12 bromhidrosis. They are all highly competent in their field, and we feel privileged to have their input in this book. I am especially grateful to my co-editors Oliver P. Kreyden and Roland Böni, who have both contributed significantly over the last few years to the establishment and success of the Hyperhidrosis Clinic at the Department of Dermatology, University Hospital of Zurich. Günter Burg, MD, Zurich Preface XII