Other Experimental Drugs

Apocrine glands produce sweat, which becomes smelly after bacterial degradation. Heckmann et al. [13] reported that botulinum toxin may decrease the production of sweat by apocrine glands, similarly to the effect on eccrine glands. The mechanism is related to the cholinergic stimulation of apocrine glands, which is inhibited by the botulinum toxin. Although based on an erroneous concept of apocrine gland involvement, botulinum toxin has been tried in the treatment of HS. Two cases of treatment of Verneuil's disease (HS) with botulinum toxin have been reported [14].

The first patient was a 29-year-old woman with recalcitrant HS, who experienced relapses after isotretinoin, zinc gluconate and antian-drogen therapy. The lesions were located in the axillary regions and mammary folds. Botuli-num toxin A (Botox®) was injected at a dose of 50 units in each axillary region and 10 units in each of the mammary folds. A complete remission was observed after 1 month. The duration of the effect was 6 months, with a disappearance of the lesions after new injections.

The second patient was a 24-year-old woman who had experienced a minor therapeutic effect of antiandrogen and isotretinoin treatment. In her case botulinum toxin (100 units) was injected in the left axillary region, allowing a left-right comparison of the effect. A clinical effect was observed as soon as 15 days after the injection. The right side was subsequently injected with 100 units 1 month later, when the difference between the two sides was dramatic. The nodules recurred after 6 months, disappearing after a new injection of botulinum toxin. Later, the same treatment was successfully used in the pubic region of the patient.

Although based on an erroneous understanding of the tissues involved in HS, these serendipitous observations appear promising, and need confirmation in more structured trials. The possible mechanism may also be interpreted to be a reflection of reduced eccrine sweat gland activity, which leads to reduced sweating and thereby indirectly to a reduction of the shear forces on the surface of the skin and the hair follicles. The appropriate doses must also be identified more precisely. Finally, the potential side-effects after several injections should be studied, as the treatment appears only to be suppressive, with a 6 months duration of effect.

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