Trichloroacetic Acid Injection for Treatment of Eyelid Apocrine Hidrocystomas in a Cat.

Apocrine hidrocystoma (AH) is a benign cystic lesion infrequently reported in the eyelids of cats. There are several reports of application of trichloroacetic acid (TCA) for treatment of eyelid apocrine hidrocystomas with high success rates in humans. This is the first report of intralesional injection of TCA for the treatment of eyelid AH in a feline. A 12-year-old Persian female spayed cat has been presented for evaluation of cystic masses on the eyelids. The cat had signs of ocular discomfort and two large cysts on the lower eyelid of the right eye. Ophthalmic examination was suggestive of eyelid AH. The cat underwent general anesthesia, and TCA 20 % was injected intracystically. The diagnosis of AH was confirmed by cytology. Two years later, there was no recurrence of the cyst. This case highlights the successful treatment of a large AH in the eyelids of a cat with TCA. Findings suggest that chemical ablation with TCA may be a useful treatment for AH in cats.

Topical glycopyrrolate followed by microneedling: a novel treatment option for eccrine hidrocystomas.

Eccrine hidrocystomas (EH) are benign cystic tumors of the eccrine glands with no established treatment yet. Eccrine glands are activated by acetylcholine released from innervating sympathetic nerve fibers. Use of oral anti-cholinergic agents is rare due to the possibility of systemic side effects while topical atropine and scopolamine have been found to be ineffective. In our patient, we tried using topical glycopyrrolate over the entire affected region followed by microneedling. Our aim was to create micro-channels through the epidermis and dermis, delivering the drug to EH lesions in the deeper dermis. We only performed microneedling over the left half of the chest to compare the difference made by microneedling. The effective percutaneous delivery of topical glycol was evident by our patient's transient systemic side effects and reduction of the EH lesions. Specifically, the lesions were reduced more significantly over the left where microneedles were applied. Our treatment was effective for our patient and he was satisfied with the improvement in cosmesis. The method described may serve as a therapeutic option for patients with EH.

Alternative Clinical Indications of Botulinum Toxin.

Botulinum toxin type A (BoNTA) is a powerful neurotoxin that inhibits acetylcholine release from presynaptic vesicles. The potency and safety profile of BoNTA grant the toxin vast therapeutic potential. It has been used off-label for a variety of dermatologic conditions. This review aims to analyze published literature regarding the benefits and risks of the off-label use of BoNTA beyond facial lines, including eccrine hidrocystomas, enlarged pores, keloids and hypertrophic scars, hidradenitis suppurativa, hyperhidrosis, masseter muscle hypertrophy, and salivary gland hypertrophy, among others. A MEDLINE search from January 2000 to December 2019 was conducted on the off-label uses of botulinum toxin in dermatology.

Treatment of multiple eccrine hidrocystoma with oral isotretinoin following erbium-yttrium aluminum garnet laser.

Eccrine hidrocystomes (EH) are benign cystic tumors of dermal eccrine ducts. There is still no gold standard treatment option for EH because of the large number of lesions, the risk of cicatrization and the different treatment options offered. We offer combined oral isotretinoin and following erbium-yttrium aluminum garnet laser treatment as an alternative treatment option in difficult patients with EH.

Intralesional botulinum toxin-A injection for the treatment of multiple eccrine hidrocystomas.

BACKGROUND: Multiple eccrine hidrocystomas (MEH) are benign cystic lesions of the sweat gland ducts. They are characterized by translucent, skin-colored or bluish dome-shaped papules on the face, causing cosmetic concern. Recently, botulinum toxin-A, because of its antiperspirant properties, has been used to treat facial MEH. However, there are only some case reports in the literature. OBJECTIVE: Here, we conducted a prospective study to assess the efficacy and safety of intralesional injection of botulinum toxin-A (Dysport) for the treatment of MEH. MATERIAL AND METHODS: Twenty patients (3 men and 17 women), aged from 31 to 75 years old, participated in this study. A 300 unit vial of botulinum toxin-A (Dysport, Ipsenn Biopharm, United Kingdom) was diluted with 4 ml of saline solution without preservative to achieve a concentration of 7.5U/.1 ml. Up to 1.5 unit of botulinum toxin was injected intradermally at the base of each lesion to raise a visible wheal. The patients were evaluated 7 days later, and any clinical changes or adverse effects were recorded. RESULTS: In all patients, more than 75% of eccrine hidrocystoma lesions resolved without any scaring. The result sustained for 2-5 months. In two patients mild smile asymmetry and in one patient lagophthalmos were noted approximately 5-7 days after injection that gradually resolved in 3 weeks. CONCLUSION: Intralesional botulinum toxin-A for treatment of multiple hidrocystomas is a simple and well-tolerated procedure. It is accompanied by excellent results, a good postoperative course, and no risk of scarring. It can be considered in patients who did not respond to other treatment or even as the first line therapy.

A rare complication of topical atropine for treatment of eccrine hidrocystoma: Pharmacological fixed dilated pupils.

Multiple eccrine hidrocystoma (EH) has been treated with topical atropine with variable results. However, in rare cases, anticholinergic side effects have been seen after the use of the topical form of this drug. We presented a 50-year-old woman who developed recent onset of visual disturbance and photophobia from 2 weeks prior. The diagnosis of topical atropine-induced bilateral mydriasis was made. We reported a recognized but often overlooked case of bilateral mydriasis caused by application of topical 1% atropine for treatment of multiple EH.

Multiple apocrine hidrocystomas successfully treated with botulinum toxin A.

Apocrine hidrocystomas, while rare, present predominantly as solitary papules occurring in the periocular region of the face. Various treatment modalities for these lesions exist depending on their size and location, but the management of multiple hidrocystomas can be more challenging. Recent reports illustrate that multiple eccrine hidrocystomas have been successfully treated with botulinum toxin A. Herein we describe the effective use of botulinum toxin A in a 29-year-old man with multiple facial apocrine hidrocystomas, which, to our knowledge, has not yet been reported in the English-language literature.

Therapeutic Hotline: Topical glycopyrrolate: a successful treatment for craniofacial hyperhidrosis and eccrine hidrocystomas.

Eccrine hidrocystoma is a benign tumor derived from eccrine sudoriparous glands. Most eccrine hidrocystomas are solitary and asymptomatic lesions. Multiple hidrocystomas are unusual and have been associated with Graves' disease, Parkinson's disease, and idiopathic craniofacial hyperhidrosis. This report describes the successful treatment of multiple center facial eccrine hidrocystomas associated with craniofacial hyperhidrosis with 0.5% glycopyrrolate aqueous solution applied locally for 1 week. The present authors obtained a very significant improvement without leaving any trace of clinical examination. Multiple eccrine hidrocystomas are a rare condition and, to date, no effective treatment has been reported. Topical glycopyrrolate is a very good first-line treatment option.