The combined use of forced cold air and topical anesthetic cream for analgesia during the treatment of palmar hyperhydrosis with botulinum toxin injections

J Drugs Dermatol. 2009 Oct;8(10):948-51.


Background: Palmar hyperhidrosis is an uncomfortable condition that can severely affect a patient's quality of life. Injections of botulinum toxin have proven to be an efficient treatment modality, however the pain associated with palmar injections has limited the use of this therapy.

Objective: The authors describe a novel method of analgesia combining topical analgesic cream and forced cold air during botulinum injection treatment of palmar hyperhidrosis.

Case report: This is a case report of a patient with a 10-year history of palmar hyperhidrosis. Both hands were pretreated with topical anesthetic cream and the right hand was additionally treated with forced cold air at a distance of 1 cm for up to 30 seconds before injection administration. After the botulinum injection was administered to both hands, the patient was subjectively asked about pain during injection.

Results: The patient subjectively reported a 75% decrease in the intensity of pain with the combination use of topical anesthetic cream and forced cold air, which she said made the injections more tolerable. No epidermal changes were noted at the time of treatment or at follow-up.

Conclusion: The use of botulinum toxin for the treatment of palmar hyperhidrosis is limited due to the pain associated with injections of the palm. In this case report, we describe the successful use of forced cold air with topical anesthetic cream to lessen the pain of botulinum toxin injections during the treatment of hyperhidrosis.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anesthetics, Local / administration & dosage*
  • Botulinum Toxins, Type A / administration & dosage*
  • Botulinum Toxins, Type A / adverse effects
  • Cold Temperature*
  • Female
  • Follow-Up Studies
  • Hand
  • Humans
  • Hyperhidrosis / drug therapy*
  • Lidocaine / administration & dosage
  • Neuromuscular Agents / administration & dosage
  • Neuromuscular Agents / adverse effects
  • Pain / chemically induced
  • Pain Management
  • Treatment Outcome


  • Anesthetics, Local
  • Neuromuscular Agents
  • Lidocaine
  • Botulinum Toxins, Type A