One of the most troublesome disadvantages associated with this therapy is pain at the injection sites. Reconstitution of botulinum toxin A in a solution of lidocaine could be an easy alternative procedure to reduce the discomfort associated with those injections.
However, the current recommendations are that botulinum toxin A should be reconstituted in normal saline. METHODS In a double-blind, side-by-side, controlled, randomized clinical trial, 29 patients hyperhidrosis dating injected with hyperhidrosis dating units of botulinum toxin A Botox ; Allergan Pharmaceuticals Ireland, Westport, Ireland reconstituted in lidocaine into one axilla and with the same dosage of the toxin, reconstituted in an equal volume of saline, into the other axilla.
The patients were followed up for 8 months. Quantification of sweat production was performed by iodine-starch tests and by the patients' own rating of sweating.
The intensity of pain associated with the botulinum toxin intracutaneous injections was self-assessed by the patients and was evaluated using a mm visual analogue scale. RESULTS Botulinum toxin A diluted in normal saline and botulinum toxin A diluted in lidocaine were similarly effective in terms of control of onset of sweat production, duration of effect and subjective percentage of mean decrease in sweating.
Both treatments were well tolerated, and there were no lasting or severe adverse effects. However, because injections of botulinum toxin A reconstituted in lidocaine are associated with significantly reduced pain, lidocaine-reconstituted botulinum toxin A hyperhidrosis dating be preferable for treating axillary hyperhidrosis.