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Anhidrotic effect of intradermal injections of botulinum toxin: A comparison of different products and concentrations
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
2008 (English)In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 88, no 3, 229-233 p.Article in journal (Refereed) Published
Abstract [en]

Botulinum toxin is used in various fields of medicine, including in the treatment of hyperhidrosis. Three products containing botulinum toxin are commercially available in Sweden; Botox, Dysport and Neurobloc. In the literature dose-response has varied with respect to these 3 products. We hypothesized that the dilution level of botulinum toxin is of importance for the effect and we therefore investigated anhidrosis after intradermal injections of each product in 3 different concentrations. Nine healthy subjects received 0.1 ml injections in the back. The anhidrotic areas were identified by an iodine-starch test after 3 weeks. When the 3 products were diluted to 100 U/ml level the achieved mean anhidrotic areas were approximately the same. This is in strong contrast with the large dose conversion factors suggested for intramuscular injections of the products. Furthermore, the lowest used concentrations for Botox(R) (25 U/ml) and Neurobloc (100 U/ml) led to the largest anhidrotic mean area per unit, respectively. The optimal concentration in this study was 25 U/ml for Botox, 100 U/ml for Dysport and 100 U/ml for Neurobloc, but for Botox and Neurobloc the optimal concentrations may be even lower.

Place, publisher, year, edition, pages
2008. Vol. 88, no 3, 229-233 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-16179DOI: 10.2340/00015555-0419ISI: 000256034500004PubMedID: 18480920OAI: oai:DiVA.org:uu-16179DiVA: diva2:43950
Available from: 2008-05-09 Created: 2008-05-09 Last updated: 2013-01-23Bibliographically approved
In thesis
1. Botulinum Toxin: Formulation, Concentration and Treatment
Open this publication in new window or tab >>Botulinum Toxin: Formulation, Concentration and Treatment
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Botulinum toxin (BTX) is used in various fields of medicine, including the treatment of hyperhidrosis and cervical dystonia. Botox®, Dysport®, Xeomin® and NeuroBloc® are commercially available BTX products, which are formulated differently and their dosing units are unique. Dosage and concentration of the prepared solution for injection varies considerably among studies comparing the products. Improved guidelines on concentration and dosing when changing from one product to another are warranted. This would ensure the use of the lowest effective doses for good effect, minimal risk of antibody formation and side-effects as well as reduced costs.

The aim of the present work was to find the most appropriate BTX concentration for each of the four products to achieve the highest sweat reducing effect and to investigate dose conversion ratios between Botox and Dysport in the treatment of cervical dystonia when the products are diluted to the same concentration, 100 U/ml.

Paper I and II clearly confirm that it is crucial to consider the BTX concentration in a treatment regimen, especially when changing between different products. The optimal concentration to reduce sweating varies among the products and was found to be 25 U/ml for Botox and Xeomin, approximately 100 U/ml for Dysport and 50 U/ml for NeuroBloc. However, for NeuroBloc the optimal concentration might be even lower.

In Paper III, which is a retrospective study using casebook notes from 75 patients with cervical dystonia, it was found that the most appropriate dose conversion ratio to use when switching from Botox to Dysport was 1:1.7.

In Paper IV, Botox and Dysport were prospectively compared in a double-blind, randomized clinical trial in two different dose conversion ratios (1:3 and 1:1.7) when diluted to the same concentration (100 U/ml). No statistically significant difference was seen between Botox (1:3) and Dysport nor between Botox (1:1.7) and Dysport four weeks after treatment. Some of the secondary outcome observations, however, did indicate that the ratio 1:3 resulted in suboptimal efficacy of Botox but this must be further validated in a larger patient material.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 67 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 816
Botulinum toxin, Botox, Dysport, Xeomin, NeuroBloc, Hyperhidrosis, Cervical dystonia
National Category
Neurology Dermatology and Venereal Diseases
Research subject
urn:nbn:se:uu:diva-181667 (URN)978-91-554-8481-1 (ISBN)
Public defence
2012-11-09, Rudbecksalen, Dag Hammarskjöldsväg 20, Uppsala, 09:15 (Swedish)
Available from: 2012-10-19 Created: 2012-09-27 Last updated: 2013-01-23Bibliographically approved

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Rystedt, AlmaSwartling, CarlNaver, Hans
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