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Dermatologic Use of Botulinum Toxin Workup

  • Author: Zoltan Trizna, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
Updated: Jan 08, 2016

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.

Contributor Information and Disclosures

Zoltan Trizna, MD, PhD Private Practice

Zoltan Trizna, MD, PhD is a member of the following medical societies: Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Desiree Ratner, MD Director, Comprehensive Skin Cancer Center, Continuum Cancer Centers of New York; Director of Dermatologic Surgery, Beth Israel Medical Center and St Luke's and Roosevelt Hospitals; Professor of Clinical Dermatology, Columbia University College of Physicians and Surgeons

Desiree Ratner, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Medical Association, American Society for Dermatologic Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.


Mary Farley, MD Dermatologic Surgeon/Mohs Surgeon, Anne Arundel Surgery Center

Disclosure: Nothing to disclose.

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