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9/9/2015
Botulinum toxin helpful in painful cutaneous leiomyomas
Botulinum toxin A may improve skin-related quality of life in patients with cutaneous leiomyomas, according to Maryland-based researchers
Botulinum toxin helpful in painful cutaneous leiomyomas

Botulinum toxin A may improve skin-related quality of life in patients with cutaneous leiomyomas, according to Maryland-based researchers.

As Dr. Edward W. Cowen told Reuters Health by email, "In this small pilot study, we provide preliminary evidence that botulinum toxin improves quality of life and may exhibit analgesic qualities in patients with significant pain related to cutaneous leiomyomas. To our knowledge, this is the first clinical trial demonstrating such a benefit with botulinum toxin for leiomyoma skin-related pain."

He further pointed out, "Cutaneous leiomyomas are benign smooth muscle proliferations that are associated with pain that is typically not well-controlled by topical remedies or systemic pain medication. Hereditary leiomyomatosis and renal cell cancer is a rare syndrome in which patients may have dozens or even hundreds of these painful tumors. We sought to determine if botulinum toxin injected directly into leiomyomas may ameliorate discomfort and improve quality of life in patients who experience significant pain from cutaneous leiomyomas."

In an August 5 online paper in JAMA Dermatology, Dr. Cowen, of the National Cancer Institute, Bethesda, and colleagues report that they randomized 18 patients to intralesional botulinum toxin A or placebo. The primary outcomes were differences in average lesional pain assessed by the Brief Pain Inventory and visual analog scale before and after ice provocation over a four-week period.

The researchers saw no significant difference in average lesional pain between groups. However, Dr. Cowen said, "We found that injection of botulinum toxin was associated with improved skin-related quality of life (p=0.007) and decreased skin-specific pain (p=0.048) on the Dermatology Life Quality Index. A trend for decreased pain (p=0.06) by visual analog score was reported in the botulinum toxin treated group compared to the placebo group."

Dr. Cowen concluded, "The mechanisms underlying the benefit of botulinum toxin for this and other pain disorders remains unclear. Botulinum toxin injection into cutaneous leiomyomas is associated with discomfort and, therefore, other routes of administration, such as topical formulation of botulinum toxin, could potentially avoid the discomfort of intralesional injection."

Commenting on the findings by email, Dr. Steven M. Daines, of Daines Plastic Surgery, Newport Beach, California, told Reuters Health, "Cutaneous leiomyomas are rare tumors that cause considerable pain and disability. Intralesional injection of botulinum toxin appears to be a treatment option that offers incremental improvement in pain symptoms and quality of life without significant risk to the patient."

The National Cancer Institute supported this study, and Allergan supplied the treatment. The authors reported no disclosures.

http://www.healthylivingmagazine.us/Articles/12292...

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