Botulinum Toxin Type A For Primary Palmoplantar Hyperhidrosis in An Adolescent: A Case Report

Abstract

Introduction: Primary hyperhidrosis is characterized by excessive sweating disproportionate to thermoregulatory needs and commonly begins during childhood or adolescence. It may cause substantial functional and psychosocial impairment. Botulinum toxin type A (BoNT-A) is a therapeutic option for focal hyperhidrosis that remains inadequately controlled with conservative therapy, although its use in pediatric patients remains limited and is considered off-label. Case: A 13-year-old boy presented with hyperhidrosis involving the palmar, plantar, and axillary regions since early childhood, with worsening symptoms over the preceding three years. The condition interfered with school activities and social interactions. Examination revealed bilateral and symmetrical hyperhidrosis, with a positive Minor’s iodine–starch test in all three regions and a Hyperhidrosis Disease Severity Scale (HDSS) score of 3. Evaluation revealed no identifiable secondary cause. Topical aluminum chloride provided inadequate symptom control, while oxybutynin and iontophoresis were unavailable. BoNT-A (Lanzox) was administered intradermally to the palmar and plantar regions following 30 minutes of topical anesthesia combined with regional nerve blocks. The total administered dose was 148 units. Discussion: At the four-week follow-up, the Minor’s iodine–starch test demonstrated reductions in the extent and intensity of staining in the palmar and plantar regions, while the HDSS score decreased from 3 to 1. The patient also reported improvements in daily functioning and self-confidence. The only reported adverse event was transient local pain, with no systemic complications. Clinical benefit was maintained throughout the six-month follow-up period. Conclusion: BoNT-A may be considered a therapeutic option for pediatric primary hyperhidrosis that causes substantial functional impairment and remains inadequately controlled with topical therapy. Its use requires individualized treatment planning, appropriate counseling and informed consent, adequate procedural pain management, and regular follow-up to assess the duration of clinical benefit and the need for repeat treatment.