Intradermal Botulinum Toxin Type A Injection Effectively Reduces Residual Limb Hyperhidrosis in Amputees: A Case Series

Abstract Charrow A, DiFazio M, Foster L, Pasquina PF, Tsao JW. Intradermal botulinum toxin type A injection effectively reduces residual limb hyperhidrosis in amputees: a case series. Objective To study the effectiveness of botulinum toxin type A (BTX-A) therapy for residual limb hyperhidrosis, prosthesis fit and function, and residual and phantom limb pain in patients with limb amputation. Design Consecutive case series. Setting Outpatient physical medicine and rehabilitation clinic. Participants Walter Reed Army Medical Center patients (N=8) with unilateral traumatic upper- or lower-limb amputation. Intervention BTX-A was injected transdermally in a circumferential pattern around the residual limb by using a 1-cm matrix grid. Main Outcome Measure A 10-cm continuous Likert visual analog scale was used to assess residual limb sweating and pain and prosthesis fit and function before and 3 weeks after BTX-A injections. Results Patients reported a significant reduction in sweating and improvement in prosthesis fit and function after treatment. However, residual limb and phantom pain were unaffected by treatment. Conclusions BTX-A may be an effective treatment for residual limb hyperhidrosis, resulting in subjective improvement in prosthesis fit and functioning. BTX-A should be considered as a method to manage excessive sweating in the residual limb of traumatic amputees.