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

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.