Botulinum Toxin Injection for the Treatment of Peri-wound Hyperhidrosis: A Case Report

Case Diagnosis: A 64-year-old male with paraplegia with a chronic right ischial stage III pressure injury and peri-wound hyperhidrosis.

Case Description or Program Description: He was admitted for respite to a spinal cord injury (SCI) unit and noted with a pressure injury. Despite strict bedrest and wound care, the pressure injury failed to heal. Dressing adherence was negatively affected by excessive peri-wound sweating. Several topical antiperspirant agents were trialed but hyperhidrosis continued to impair wound healing, so Botulinum toxin injection of the peri-wound area was performed. 200 units of incobotulinumtoxin A were reconstituted in 8 milliliters of sterile 0.9% normal saline. Iodine solution, then cornstarch, were applied to identify areas of peri-wound hyperhidrosis. Marks were made with a surgical pen within the hyperpigmented areas measured 2 centimeters (cm) apart and then injected with 0.1 milliliters of solution (2.5 units of botulinum toxin) each.

Setting: Tertiary Care Hospital

Assessment/Results: Serial wound measurements showed improvement in size, from 3 x 0.5 x 0.1 cm prior to injection to 0.8 x 0.3 x 0.1 cm five weeks after injection. No adverse events were recorded.

Discussion (relevance): Pressure injuries are frequent and costly complications for individuals with SCI. Moisture accumulation, as from hyperhidrosis, can negatively affect skin integrity and wound healing by decreasing the barrier function of the skin and impeding dressing adherence. Botulinum toxin injections are commonly used and well-tolerated in the treatment of axillary and palmar hyperhidrosis. Toxin temporarily decreases sweat gland secretion by targeting sympathetic cholinergic neurons. Literature review found one case series discussing Botulinum toxin injection used to treat hyperhidrosis in two individuals with prosthesis-related residual limb wounds. To our knowledge, there have been no reported cases of Botulinum toxin injections used for treatment of hyperhidrosis impairing pressure injury healing in individuals with SCI.

Conclusions: Botulinum toxin injections may be used for the treatment of hyperhidrosis impairing pressure injury healing.