eMedicine Specialties > Dermatology > Surgical

Botulinum Toxin: Workup

Author: Zoltan Trizna, MD, PhD, Private Practice
Contributor Information and Disclosures

Updated: Feb 20, 2009

Workup

Diagnostic Procedures

  • Electromyography (EMG) is useful in exactly identifying the muscles underlying the wrinkles, especially the smaller muscles. EMG is also a good teaching tool.
    • To perform the procedure, the active EMG electrode is inserted into the muscle and slowly advanced until a signal of maximum intensity is detected. This signal is generated by the contraction of the target muscle. The botulinum toxin is injected into the identified area.
    • EMG is time consuming and adds to the expense of the procedure. Therefore, it is not frequently used in the general dermatologic practice.
    • Several portable devices are available.
  • The starch-iodine test visually demonstrates the extent of hyperhidrosis and indicates the amount of sweating.
    • This test is performed by exposing the hyperhidrotic area to paper impregnated with iodine or by layering a starch-iodine mixture onto the skin. The paper method may be better on the palms and soles, whereas layering the mixture is easier in the axillae.
    • This test is contraindicated in patients with hypersensitivity to iodine.
    • The presence of sweat results in a blue-black pigment reaction after about 10 minutes. By photocopying the paper or photographing the area, permanent documentation is achieved.
  • Sweating can be quantitatively measured by placing bibulous paper on the affected area.
    • After a period of time, the increase in the weight of the paper is documented.
    • Repeated measurements should be obtained under the same conditions of ambient temperature and elapsed time.

More on Botulinum Toxin

Overview: Botulinum Toxin
Workup: Botulinum Toxin
Treatment: Botulinum Toxin
Follow-up: Botulinum Toxin
References
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References

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  23. Braune C, Erbguth F, Birklein F. Dose thresholds and duration of the local anhidrotic effect of botulinum toxin injections: measured by sudometry. Br J Dermatol. Jan 2001;144(1):111-7. [Medline].

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Further Reading

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Keywords

botulinum toxin, botulinum toxin type A, botulinum toxin type B, BOTOX®, BOTOX, Myobloc, Elan, Neurobloc, Dysport, Clostridium botulinum, C botulinum, botulism, wrinkles, crow's feet, frown lines, bunny lines

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Contributor Information and Disclosures

Author

Zoltan Trizna, MD, PhD, Private Practice
Zoltan Trizna, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Désirée Ratner, MD, Director of Dermatologic Surgery, Professor of Clinical Dermatology, Department of Dermatology, Columbia University Medical Center, New York Presbyterian Hospital
Désirée Ratner, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Medical Association, American Society for Dermatologic Surgery, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Mary Farley, MD, Dermatologic Surgeon/Mohs Surgeon, Anne Arundel Surgery Center
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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