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A CASE SERIES OF CRANIOFACIAL HYPERHYDROSIS: CLINICAL CHARACTERISTICS AND TREATMENT WITH BOTULINUM TOXIN
  1. M Marion*,
  2. G Kyei
  1. Atkinson Morley Neuroscience centre, St George's Hospital

    Abstract

    Introduction Craniofacial hyperhidrosis is a disabling condition, likely caused by an overactive neural pathway. We describe clinical characteristics and response to Botulinum toxin A injections.

    Method 17 patients with craniofacial hyperhidrosis were prospectively studied. Exclusion criteria included sweating secondary to autonomic disease or unilateral/localized/gustatory sweating secondary to diabetes or Frey Syndrome.

    Results Three groups emerged:

    1. Familial early onset, childhood to puberty, n=8 88% also suffered hyperhidrosis at axillae/palmar-plantar/back areas. 75% had positive family history. Males : females=1 : 1. Triggers included anxiety, heat and physical exertion.

    2. Adult onset, 27–30 years, n=5 60% had isolated facial sweating. 80% had negative family history. Males : females=4 : 1. 100% had psychiatric comorbidity. Citalopram triggered sweating in one case.

    3. Late adult onset, 50–65 years, n=4 100% had negative family history. Males : females=1 : 1. Systemic comorbidities were lupus, acromegaly, polymyalgia rheumatica. Sweating worsened at night and was unaffected by emotion.

    Botulinum toxin A injections were well-tolerated with no significant side-effects and duration 4–12 months. Injection techniques will be demonstrated via video.

    Conclusion Craniofacial sweating is a heterogeneous disorder. Three distinct groups are apparent. Botulinum toxin A injections are effective and well-tolerated.

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