1309 - Axillary Hygiene Management with Botulinum Toxin Type A in a Patient with Post-Stroke Spasticity

A 52 year old female patient presented to our outpatient clinic following an ischemic stroke from complete occlusion of the right middle cerebral artery. Her chief concern was ongoing muscle tightness around her shoulder, which made it difficult for her to maintain cleanliness and led to numerous fungal injections in her axilla. For her spasticity, she tried physical therapy, oral baclofen, and botulinum toxin to her shoulder adductors.  For axillary hygiene, she tried various antiperspirants and antifungal agents.  

While her spasticity improved with this therapy she still had difficulty managing axillary hygiene, producing odor and recurrent candidal infections. Given her unresolved symptoms, we made a joint decision to inject botulinum toxin into her axilla, in addition to her usual injections. We injected 50 units of onabotulinumtoxinA into her axilla, diluted to 100 units/2ml with preservative-free normal saline in a grid-like pattern intradermally, spaced 1 cm apart.

Discussions: OnabotulinumtoxinA (Botox ®) is FDA-approved for primary axillary hyperhidrosis. Although our patient did not fit the criteria for this condition, she experienced similar symptoms in terms of perspiration causing issues with odor and infections. Conventional treatments, including antiperspirants and antifungals failed to reduce her symptoms. Since starting botulinum toxin treatments to her axilla, she has not experienced any axillary hygiene issues, nor has had fungal infections, and reports high satisfaction with the results.

Conclusions: Ongoing botulinum toxin injections may prove useful in the management of patients with spasticity who are at risk for axillary hygiene impairment. To our knowledge, this is the first reported case on the use of botulinum toxin for axillary hygiene for a post-stroke patient with spasticity.