Refractory pruritic Fox-Fordyce disease successfully treated with botulinum toxin type A.

Abstract

Editors, Fox-Fordyce disease (FFD) was first described in 1902 by Fox and Fordyce 1 in 2 patients with axillary disease. FFD is a chronic, pruritic, papular eruption involving apocrine-gland– rich areas. It most commonly affects women between the ages of 15 and 35 years with a female-to-male ratio up to 13:1. 2 A 30-year-old Saudi female presented to our dermatology clinic complaining of a 7-year history of intensely pruritic papules over both axillae. There was no hyperhidrosis or axillary chromhidrosis. There was neither fluctuation in pruritus during the day or before menstruation nor a his- tory of laser therapy in the affected areas. Over the last 7 years, multiple treatment modalities were tried, including topical and intralesional corticosteroid, topical tacrolimus 0.1% ointment, 1% clindamycin solution, topical tretinoin 0.05%, an oral antihistamine, topical aluminum chloride hexahydrate 20%, oral isotretinoin up to 1 mg/kg for 6 months, and multiple sessions of electrosurgery. There was no significant reduction either in pruritus intensity or in the number of papules. Her main complaint was intense pruritus, rated using the Visual Analogue Scale as being 10/10. The severity the patient’s pruritus significantly her daily quality of life. Her Dermatology Life Quality Index was 19.