Needle-Free Administration of Botulinum Toxin for Primary Focal Hyperhidrosis: Initial Experience

Local intradermal injections of botulinum toxin (BTX) effectively provide symptom relief of primary focal hyperhidrosis (PFHH), but they can be painful and a deterrent for repeated treatments. The EnerJet system delivers therapeutic substances into the dermis via a high-pressure liquid jet. In this proof-of-concept trial, BTX was administered by the EnerJet system without anesthesia. The pre- and 4 weeks' post-treatment disease severity and symptom burden were assessed [Hyperhidrosis Disease Severity Scale (HDSS), the Dermatology Life Quality Index (DLQI) and Minor starchiodine tests]. All 11 patients had severe PFHH. The number of required shots ranged between 50-90 for the bilateral axillary areas and 75-100 for the palmar areas. Total reduction of DLQI and HDSS scores at 4 weeks post-EnerJet system treatment indicated improvement in symptom burden and quality of life. BTX delivery by the EnerJet system may be a simple and effective alternative to conventional BTX injections.