Disclosures: Hannah Uhlig-Reche: No financial relationships or conflicts of interest

Case Description: The patient sustained a C5 ASIA Impairment Scale B spinal cord injury (SCI) and traumatic brain injury (TBI) after a motor vehicle accident for which he was admitted to inpatient rehabilitation (IPR) for 6 months. He experienced a stage III sacral pressure ulcer which caused persistent issues despite repositioning and treatment by a wound care specialist. Two years after injury, while visiting for outpatient management of spasticity, he was noted to have continued sacral skin issues (Figure 1a).

Setting: Outpatient PM&R Clinic.

Patient: A male sustaining a SCI and TBI at age 22 years. Assessment/

Results: A trial of 100 units of onabotulinumtoxinA was split bilaterally to the eccrine glands around the intergluteal cleft. Within several weeks the patient noted improvement of the skin which remained healed at his follow-up appointment three months later (Figure 1b). Repeat injections every 6-8 months have successfully maintained skin integrity without complication.

Discussion: Chronic skin wounds are common post-neurologic injury due to immobility, insensate skin, incontinence, or dependence of self-care. While pressure-relieving techniques are the primary approach to prevention and treatment of such wounds, some require additional therapies like botulinum toxin injections. Oftentimes, the toxin is injected into muscles hindering mobility or causing recurrent spasms thereby contributing to wound formation. However, hyperhidrosis can also result in skin maceration. Toxin use in the treatment of primary hyperhidrosis of the axillae, groin, and palms/soles has been well-described yet its application to the eccrine glands near the intergluteal cleft has not been.

Conclusion: When treating SCI or TBI patients, one must consider the various possible medical complications, including chronic skin wounds. Etiology of the wound should be investigated so treatment can be effectively targeted and the wound managed expeditiously. In cases of skin wounds secondary to hyperhidrosis, botulinum toxin to the eccrine glands of that region offers a quick, safe, and effective treatment option.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/buttox-treatment-of-secondary-hyperhidrosis-of-the-intergluteal-cleft-with-botulinum-toxin-a-case-report/