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February 19, 2020

Onabotulinum Toxin A for Sacral and Intergluteal Cleft Hyperhidrosis

Author Affiliations
  • 1Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
  • 2Skin Surgery Center, Seattle, Washington
JAMA Dermatol. 2020;156(4):470-471. doi:10.1001/jamadermatol.2019.4757

Excessive sweating can affect a patient’s social and professional life and can be a source of great embarrassment. Botulinum toxin A was shown to be both safe and efficacious for the treatment of axillary, palmar, and plantar hyperhidrosis in previous studies.1,2 Eccrine sweat glands are innervated by postganglionic sympathetic fibers of the nervous system, where acetylcholine functions as the main neurotransmitter. Botulinum toxin A acts on synaptosomal-associated protein of 25-kDa (SNAP-25) to block the release of acetylcholine, thereby decreasing sweat production. Although a few case reports and small case series have found botulinum toxin A to be effective for the treatment of inguinal hyperhidrosis and hyperhidrosis of the anal fold,3-5 to our knowledge there are no studies to date on the use of botulinum toxin A for the treatment of hyperhidrosis of the intergluteal cleft and sacrum. In this observation, we report an example of use of onabotulinum toxin A for the treatment of intergluteal and sacral hyperhidrosis.

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