array:24 [
  "pii" => "S1578219014001176"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2014.04.011"
  "estado" => "S300"
  "fechaPublicacion" => "2014-06-01"
  "aid" => "933"
  "copyright" => "Elsevier España, S.L. and AEDV"
  "copyrightAnyo" => "2013"
  "documento" => "simple-article"
  "crossmark" => 0
  "subdocumento" => "crp"
  "cita" => "Actas Dermosifiliogr. 2014;105:517-8"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 12409
    "formatos" => array:3 [
      "EPUB" => 50
      "HTML" => 5578
      "PDF" => 6781
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0001731013004286"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2013.11.006"
      "estado" => "S300"
      "fechaPublicacion" => "2014-06-01"
      "aid" => "933"
      "copyright" => "Elsevier España, S.L. y AEDV"
      "documento" => "simple-article"
      "crossmark" => 0
      "subdocumento" => "crp"
      "cita" => "Actas Dermosifiliogr. 2014;105:517-8"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 11177
        "formatos" => array:3 [
          "EPUB" => 3
          "HTML" => 6634
          "PDF" => 4540
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">V&#237;deos de cirug&#237;a dermatol&#243;gica</span>"
        "titulo" => "T&#233;cnica de infiltraci&#243;n de toxina botul&#237;nica en hiperhidrosis axilar"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "517"
            "paginaFinal" => "518"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Botulinum Toxin Injection Technique for Axillary Hyperhidrosis"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1327
                "Ancho" => 1990
                "Tamanyo" => 780034
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Material necesario&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "J&#46; del Boz, L&#46; Padilla-Espa&#241;a, J&#46;M&#46; Segura-Palacios"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "del Boz"
              ]
              1 => array:2 [
                "nombre" => "L&#46;"
                "apellidos" => "Padilla-Espa&#241;a"
              ]
              2 => array:2 [
                "nombre" => "J&#46;M&#46;"
                "apellidos" => "Segura-Palacios"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219014001176"
          "doi" => "10.1016/j.adengl.2014.04.011"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014001176?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731013004286?idApp=UINPBA000044"
      "url" => "/00017310/0000010500000005/v1_201405270041/S0001731013004286/v1_201405270041/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1578219014001103"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2014.04.004"
    "estado" => "S300"
    "fechaPublicacion" => "2014-06-01"
    "aid" => "916"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "cor"
    "cita" => "Actas Dermosifiliogr. 2014;105:519-20"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1273
      "formatos" => array:3 [
        "EPUB" => 48
        "HTML" => 947
        "PDF" => 278
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>"
      "titulo" => "Condyloma Acuminata in Male Patients&#46; Are There Differences Between the Immigrant and Autochthonous Populations&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "519"
          "paginaFinal" => "520"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Condilomas acuminados en varones&#46; &#191;Existen diferencias entre poblaci&#243;n inmigrante y aut&#243;ctona&#63;"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "R&#46;M&#46; D&#237;az D&#237;az, C&#46; Garrido Guti&#233;rrez, A&#46; Navarro Cantero, E&#46; Ru&#237;z Bravo-Burguillos"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "R&#46;M&#46;"
              "apellidos" => "D&#237;az D&#237;az"
            ]
            1 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Garrido Guti&#233;rrez"
            ]
            2 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Navarro Cantero"
            ]
            3 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Ru&#237;z Bravo-Burguillos"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731013003761"
        "doi" => "10.1016/j.ad.2013.10.008"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731013003761?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014001103?idApp=UINPBA000044"
    "url" => "/15782190/0000010500000005/v1_201405281018/S1578219014001103/v1_201405281018/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1578219014001218"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2014.04.015"
    "estado" => "S300"
    "fechaPublicacion" => "2014-06-01"
    "aid" => "915"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and AEDV"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "cor"
    "cita" => "Actas Dermosifiliogr. 2014;105:515-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2290
      "formatos" => array:3 [
        "EPUB" => 43
        "HTML" => 1308
        "PDF" => 939
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case for Diagnosis</span>"
      "titulo" => "Ulcer on the Scrotum"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "515"
          "paginaFinal" => "516"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "&#218;lcera en el escroto"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:6 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1287
              "Ancho" => 1669
              "Tamanyo" => 319596
            ]
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "L&#46;C&#46; Arango-Duque, S&#46; Blanco-Barrios, E&#46; Fern&#225;ndez-L&#243;pez"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "L&#46;C&#46;"
              "apellidos" => "Arango-Duque"
            ]
            1 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Blanco-Barrios"
            ]
            2 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Fern&#225;ndez-L&#243;pez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S000173101300375X"
        "doi" => "10.1016/j.ad.2013.10.007"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101300375X?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014001218?idApp=UINPBA000044"
    "url" => "/15782190/0000010500000005/v1_201405281018/S1578219014001218/v1_201405281018/en/main.assets"
  ]
  "en" => array:16 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Videos of Surgical Procedures in Dermatology</span>"
    "titulo" => "Botulinum Toxin Injection Technique for Axillary Hyperhidrosis"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "517"
        "paginaFinal" => "518"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "J&#46; del Boz, L&#46; Padilla-Espa&#241;a, J&#46;M&#46; Segura-Palacios"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "J&#46;"
            "apellidos" => "del Boz"
            "email" => array:1 [
              0 => "javierdelboz&#64;yahoo&#46;es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "L&#46;"
            "apellidos" => "Padilla-Espa&#241;a"
          ]
          2 => array:2 [
            "nombre" => "J&#46;M&#46;"
            "apellidos" => "Segura-Palacios"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital Costa del Sol&#44; Marbella&#44; M&#225;laga&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "T&#233;cnica de infiltraci&#243;n de toxina botul&#237;nica en hiperhidrosis axilar"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1105
            "Ancho" => 1658
            "Tamanyo" => 356494
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Division of the axilla into quadrants&#44; with the sites of injection situated in the center&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">An approved indication for botulinum toxin &#40;BT&#41; is for the treatment of severe and persistent primary hyperhidrosis of the axilla that interferes with the activities of daily living and that is resistant to topical treatment&#46; This is currently the only approved indication for botulinum toxin type A &#40;BTA&#41;&#44; marketed as Botox and presented in the form of vials containing 100<span class="elsevierStyleHsp" style=""></span>units&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Prior to indicating this procedure&#44; the medical history must be taken&#44; a physical examination performed&#44; and specific additional tests done as required to exclude possible causes of secondary hyperhidrosis and avoid the symptomatic treatment of hyperhidrosis without the diagnosis and&#47;or treatment of an underlying disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Clinical improvement usually develops within a week after the injection&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> The injection of BT can be repeated when the clinical effect of the previous injection declines and the specialist considers it necessary&#59; however&#44; it is not advisable to repeat injections at intervals of less than 16 weeks&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Description of the Technique</span><p id="par0020" class="elsevierStylePara elsevierViewall">Prior to injection&#44; the area of axillary hyperhidrosis to be treated can be identified using the starch-iodine technique &#40;the Minor test&#41;&#46; The quadrants to be treated are defined and antiseptic is applied&#46; The quadrants can be marked on a transparent dressing rather than on the skin in order to avoid the risk that the marks become blurred by the sweat&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The discomfort associated with the procedure can be minimized by the subcutaneous injection of local anesthetic&#44; or topical anesthesia can be applied prior to starting the procedure&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The vial of 100<span class="elsevierStyleHsp" style=""></span>units of BTA is reconstituted by dissolution in 0&#46;9&#37; saline solution &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#59; though the volume of solution for reconstitution of the vial can be varied&#44; it is usually done with 5<span class="elsevierStyleHsp" style=""></span>mL&#44; which will give us a concentration of 2<span class="elsevierStyleHsp" style=""></span>units in every 0&#46;1<span class="elsevierStyleHsp" style=""></span>mL of the resulting solution&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">As a rule&#44; 50<span class="elsevierStyleHsp" style=""></span>U are administered into each axilla&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> injected intradermally using sterile 30<span class="elsevierStyleHsp" style=""></span>gauge needles&#44; making the injections as equally spaced as possible over the area of hyperhidrosis&#44; separated by 1 to 2<span class="elsevierStyleHsp" style=""></span>cm &#40;depending on the size of the area to be treated&#41;&#46; Typically&#44; 25 injections are made per axilla &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; injecting 0&#46;1<span class="elsevierStyleHsp" style=""></span>mL &#40;2<span class="elsevierStyleHsp" style=""></span>units&#41; at each site&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Precautions and Contraindications</span><p id="par0035" class="elsevierStylePara elsevierViewall">There is no approved indication for the use of BTA in the treatment of hyperhidrosis of the axilla in patients under 18 years of age or in pregnant or breastfeeding women as there is insufficient data concerning safety and efficacy&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The use of BTA in patients with neuromuscular disorders must be performed with extreme caution and under strict supervision due to the risk of onset of excessive muscle weakness&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The procedure is contraindicated in patients with known hypersensitivity to BTA or to any of the excipients of the preparation and in patients with infection in the area of the proposed sites of injection&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In theory&#44; the effect of BT can be potentiated by the aminoglycoside antibiotics and spectinomycin&#44; as well as by other drugs that interfere with neuromuscular transmission&#44; such as the neuromuscular blocking agents&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Variations in the clinical effect after repeated use of BTA may be due to the use of different procedures for reconstitution of the vial&#44; different intervals between injection&#44; and slight variations in the potency of the toxin due to the biological process used for its synthesis&#46; The formation of neutralizing antibodies to BTA can reduce the effectiveness of treatment&#59; injection of the minimum effective dose at the maximum possible interval between injections is therefore recommended to minimize the risk of formation of these antibodies&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Complications</span><p id="par0060" class="elsevierStylePara elsevierViewall">Complications of this technique are uncommon &#40;11&#37; according to the summary of product characteristics<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#41; and the large majority are minor and transitory&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> As with any injection&#44; the technique can give rise to infection&#44; pain&#44; inflammation&#44; paresthesia&#44; hypoesthesia&#44; swelling&#44; edema&#44; erythema&#44; and localized hemorrhage or hematomas &#40;often related more to the previous injection of local anesthetic&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The pain associated with insertion of the needles and&#47;or anxiety can give rise to vasovagal reactions&#46; In very rare cases &#40;0&#46;7&#37;&#41;&#44; transitory muscle weakness can develop in the upper limb&#46; In addition&#44; about 4&#46;5&#37; of patients develop excess sweating in untreated areas &#40;including areas without previous hyperhidrosis&#41;&#44; and this can persist for up to a month&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Severe or immediate hypersensitivity reactions&#44; including anaphylaxis&#44; serum sickness&#44; urticaria&#44; soft tissue edema&#44; and dyspnea have been reported rarely&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="par0075" class="elsevierStylePara elsevierViewall">The injection of botulinum toxin for the treatment of axillary hyperhidrosis is a simple procedure that is relatively quick to perform and has a low risk of complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4</span></a> The technique produces a high level of satisfaction in a large majority of patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The main limitations to the technique are the transitory nature of its effect and the cost of the vial of botulinum toxin&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of Interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:7 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Description of the Technique"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Precautions and Contraindications"
        ]
        3 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Complications"
        ]
        4 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conclusions"
        ]
        5 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflicts of Interest"
        ]
        6 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; del Boz J&#44; Padilla-Espa&#241;a L&#44; Segura-Palacios JM&#46; T&#233;cnica de infiltraci&#243;n de toxina botul&#237;nica en hiperhidrosis axilar&#46; Actas Dermosifiliogr&#46; 2014&#59;105&#58;517&#8211;518&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0095" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0040"
          ]
        ]
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1106
            "Ancho" => 1659
            "Tamanyo" => 466426
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Material required&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1105
            "Ancho" => 1658
            "Tamanyo" => 356494
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Division of the axilla into quadrants&#44; with the sites of injection situated in the center&#46;</p>"
        ]
      ]
      2 => array:5 [
        "identificador" => "upi0005"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:3 [
          "fichero" => "mmc1.mp4"
          "ficheroTamanyo" => 43209881
          "Video" => array:2 [
            "flv" => array:5 [
              "fichero" => "mmc1.flv"
              "poster" => "mmc1.jpg"
              "tiempo" => 0
              "alto" => 0
              "ancho" => 0
            ]
            "mp4" => array:2 [
              "fichero" => "mmc1.m4v"
              "poster" => "mmc1.jpg"
            ]
          ]
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:5 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Botox summary of product characteristics&#46; Available at&#58; <a id="intr0010" class="elsevierStyleInterRef" href="http://www.aemps.gob.es/cima/pdfs/es/ft/63194/FT_63194.pdf">http&#58;&#47;&#47;www&#46;aemps&#46;gob&#46;es&#47;cima&#47;pdfs&#47;es&#47;ft&#47;63194&#47;FT&#95;63194&#46;pdf</a>&#46; Accessed January 14&#44; 2014&#46;"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Toxina botul&#237;nica A en el tratamiento de la hiperhidrosis primaria&#58; estudio prospectivo de 52 pacientes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Mart&#237;"
                            1 => "D&#46; Ram&#243;n"
                            2 => "L&#46; G&#225;mez"
                            3 => "I&#46; Reiga"
                            4 => "M&#46;A&#46; Garc&#237;a P&#233;rez"
                            5 => "V&#46; Alonso"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2010"
                        "volumen" => "101"
                        "paginaInicial" => "614"
                        "paginaFinal" => "621"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20858387"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Actualizaci&#243;n en hiperhidrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;A&#46; Callejas"
                            1 => "R&#46; Grimalt"
                            2 => "E&#46; Cladellas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2010"
                        "volumen" => "101"
                        "paginaInicial" => "110"
                        "paginaFinal" => "118"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20223153"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy of botulinum toxin type A in the treatment of focal axillary hyperhidrosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;S&#46; Absar"
                            1 => "M&#46; Onwudike"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1524-4725.2008.34142.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Surg"
                        "fecha" => "2008"
                        "volumen" => "34"
                        "paginaInicial" => "751"
                        "paginaFinal" => "755"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18318723"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of a transparent dressing in the treatment of axillary hyperhidrosis with botulinum toxin type A"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Gal&#225;n-Guti&#233;rrez"
                            1 => "G&#46; Garnacho-Saucedo"
                            2 => "R&#46; Salido-Vallejo"
                            3 => "A&#46; V&#233;lez Garcia-Nieto"
                            4 => "J&#46;C&#46; Moreno-Gim&#233;nez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2010"
                        "volumen" => "63"
                        "paginaInicial" => "111"
                        "paginaFinal" => "112"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000010500000005/v1_201405281018/S1578219014001176/v1_201405281018/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6209"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Videos of Surgical Procedures in Dermatology"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010500000005/v1_201405281018/S1578219014001176/v1_201405281018/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014001176?idApp=UINPBA000044"
]
Share
Journal Information
Vol. 105. Issue 5.
Pages 517-518 (June 2014)
Visits
42125
Vol. 105. Issue 5.
Pages 517-518 (June 2014)
Videos of Surgical Procedures in Dermatology
Full text access
Botulinum Toxin Injection Technique for Axillary Hyperhidrosis
Técnica de infiltración de toxina botulínica en hiperhidrosis axilar
Visits
42125
J. del Boz
Corresponding author
javierdelboz@yahoo.es

Corresponding author.
, L. Padilla-España, J.M. Segura-Palacios
Servicio de Dermatología, Hospital Costa del Sol, Marbella, Málaga, Spain
This item has received
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (2)
Additional material (1)
Full Text
Introduction

An approved indication for botulinum toxin (BT) is for the treatment of severe and persistent primary hyperhidrosis of the axilla that interferes with the activities of daily living and that is resistant to topical treatment. This is currently the only approved indication for botulinum toxin type A (BTA), marketed as Botox and presented in the form of vials containing 100units.1,2

Prior to indicating this procedure, the medical history must be taken, a physical examination performed, and specific additional tests done as required to exclude possible causes of secondary hyperhidrosis and avoid the symptomatic treatment of hyperhidrosis without the diagnosis and/or treatment of an underlying disease.2,3

Clinical improvement usually develops within a week after the injection.2–4 The injection of BT can be repeated when the clinical effect of the previous injection declines and the specialist considers it necessary; however, it is not advisable to repeat injections at intervals of less than 16 weeks.1

Description of the Technique

Prior to injection, the area of axillary hyperhidrosis to be treated can be identified using the starch-iodine technique (the Minor test). The quadrants to be treated are defined and antiseptic is applied. The quadrants can be marked on a transparent dressing rather than on the skin in order to avoid the risk that the marks become blurred by the sweat.5 The discomfort associated with the procedure can be minimized by the subcutaneous injection of local anesthetic, or topical anesthesia can be applied prior to starting the procedure.

The vial of 100units of BTA is reconstituted by dissolution in 0.9% saline solution (Fig. 1); though the volume of solution for reconstitution of the vial can be varied, it is usually done with 5mL, which will give us a concentration of 2units in every 0.1mL of the resulting solution.

Figure 1.

Material required.

(0.44MB).

As a rule, 50U are administered into each axilla,1 injected intradermally using sterile 30gauge needles, making the injections as equally spaced as possible over the area of hyperhidrosis, separated by 1 to 2cm (depending on the size of the area to be treated). Typically, 25 injections are made per axilla (Fig. 2), injecting 0.1mL (2units) at each site.3

Figure 2.

Division of the axilla into quadrants, with the sites of injection situated in the center.

(0.34MB).
Precautions and Contraindications

There is no approved indication for the use of BTA in the treatment of hyperhidrosis of the axilla in patients under 18 years of age or in pregnant or breastfeeding women as there is insufficient data concerning safety and efficacy.1

The use of BTA in patients with neuromuscular disorders must be performed with extreme caution and under strict supervision due to the risk of onset of excessive muscle weakness.1,3

The procedure is contraindicated in patients with known hypersensitivity to BTA or to any of the excipients of the preparation and in patients with infection in the area of the proposed sites of injection.1,3

In theory, the effect of BT can be potentiated by the aminoglycoside antibiotics and spectinomycin, as well as by other drugs that interfere with neuromuscular transmission, such as the neuromuscular blocking agents.1,3

Variations in the clinical effect after repeated use of BTA may be due to the use of different procedures for reconstitution of the vial, different intervals between injection, and slight variations in the potency of the toxin due to the biological process used for its synthesis. The formation of neutralizing antibodies to BTA can reduce the effectiveness of treatment; injection of the minimum effective dose at the maximum possible interval between injections is therefore recommended to minimize the risk of formation of these antibodies.1

Complications

Complications of this technique are uncommon (11% according to the summary of product characteristics1) and the large majority are minor and transitory.2–4 As with any injection, the technique can give rise to infection, pain, inflammation, paresthesia, hypoesthesia, swelling, edema, erythema, and localized hemorrhage or hematomas (often related more to the previous injection of local anesthetic).1

The pain associated with insertion of the needles and/or anxiety can give rise to vasovagal reactions. In very rare cases (0.7%), transitory muscle weakness can develop in the upper limb. In addition, about 4.5% of patients develop excess sweating in untreated areas (including areas without previous hyperhidrosis), and this can persist for up to a month.1

Severe or immediate hypersensitivity reactions, including anaphylaxis, serum sickness, urticaria, soft tissue edema, and dyspnea have been reported rarely.1,3

Conclusions

The injection of botulinum toxin for the treatment of axillary hyperhidrosis is a simple procedure that is relatively quick to perform and has a low risk of complications.2,4 The technique produces a high level of satisfaction in a large majority of patients.2–4

The main limitations to the technique are the transitory nature of its effect and the cost of the vial of botulinum toxin.2,4

Conflicts of Interest

The authors declare that they have no conflicts of interest.

References
[1]
Botox summary of product characteristics. Available at: http://www.aemps.gob.es/cima/pdfs/es/ft/63194/FT_63194.pdf. Accessed January 14, 2014.
[2]
N. Martí, D. Ramón, L. Gámez, I. Reiga, M.A. García Pérez, V. Alonso, et al.
Toxina botulínica A en el tratamiento de la hiperhidrosis primaria: estudio prospectivo de 52 pacientes.
Actas Dermosifiliogr, 101 (2010), pp. 614-621
[3]
M.A. Callejas, R. Grimalt, E. Cladellas.
Actualización en hiperhidrosis.
Actas Dermosifiliogr, 101 (2010), pp. 110-118
[4]
M.S. Absar, M. Onwudike.
Efficacy of botulinum toxin type A in the treatment of focal axillary hyperhidrosis.
Dermatol Surg, 34 (2008), pp. 751-755
[5]
M. Galán-Gutiérrez, G. Garnacho-Saucedo, R. Salido-Vallejo, A. Vélez Garcia-Nieto, J.C. Moreno-Giménez.
Use of a transparent dressing in the treatment of axillary hyperhidrosis with botulinum toxin type A.
J Am Acad Dermatol, 63 (2010), pp. 111-112

Please cite this article as: del Boz J, Padilla-España L, Segura-Palacios JM. Técnica de infiltración de toxina botulínica en hiperhidrosis axilar. Actas Dermosifiliogr. 2014;105:517–518.

Copyright © 2013. Elsevier España, S.L. and AEDV
Download PDF
Idiomas
Actas Dermo-Sifiliográficas
Article options
Tools
Supplemental materials
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?