What is the role of botulinum toxin A in the treatment of vesicular palmoplantar eczema?

Updated: Aug 23, 2019
  • Author: Jessica Dunkley, MD, MHSc, CCFP; Chief Editor: Dirk M Elston, MD  more...
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Answer

Botulinum toxin A is a potent neurotoxin that blocks the autonomic cholinergic fibers. [54, 55] It has been shown to improve symptoms of itching and vesicular formation in a controlled left-right hand comparison study with 8 subjects. [56] This therapy may be used alone or in combination with topical steroids. However, the mechanism of action in reducing the severity of palmoplantar eczema is disputed. Some proposed mechanisms are a disruption of the afferent nerve supply of the skin, which may reduce sweating, because sweat is known to exacerbate the condition. Another mechanism is the possible effect of the toxin on afferent nerve fibers. Blockade of the inflammatory process and inhibition of neuropeptides such as substance P via toxic effects may explain the reduction of pruritus in treated patients. One case report showed improvement of relapsing dyshidrotic eczema with treatment of coexisting hyperhidrosis with the anticholinergic oxybutynin. [57]


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