Botulinum Toxin Type A Shows Promise as Add-On Treatment for HS, reports research

A recent study found that the off-label use of botulinum toxin type A (BoNT-A) can be an effective add-on treatment for symptom control in patients with hidradenitis suppurativa (HS). Led by Noor F. Goandal from Zealand University Hospital, the study highlights the continued need for alternative therapies despite the availability of biologics like secukinumab, adalimumab, and bimekizumab. BoNT-A, known for treating hyperhidrosis, may also reduce inflammation by inhibiting mast cell degranulation, a key factor in HS severity.

The retrospective case series analyzed eight HS patients treated with BoNT-A between 2018 and 2023. Investigators assessed treatment efficacy using numeric rating scales (NRS) and a Likert scale to evaluate suppuration, pain relief, and effects on daily activities. Participants reported high satisfaction with a median NRS score of 8.5. A moderate reduction was noted among six patients with suppuration (median NRS 6.5).

Pain relief was also moderate (median score 2.5), while improvements in work/education were minimal (median score 0.5). Physical activity showed some enhancement (median score 1.5). All participants said they would recommend the treatment. The study's pain reduction findings align with prior research on BoNT-A and a randomised trial of botulinum toxin type B for hidradenitis suppurativa. Compared to tetracycline, which significantly lowered pain scores from 6 to 4, and adalimumab, which reduced pain by 30%, BoNT-A showed moderate but promising results. Researchers attribute these benefits to its inhibition of neurogenic inflammation and mast cell degranulation, potentially reducing abscess formation.

The authors emphasize the need for a randomized, placebo-controlled study to further evaluate BoNT-A’s effects on pain, suppuration, quality of life, and disease severity. Their findings lay the groundwork for future research on BoNT-A as a potential hidradenitis suppurativa treatment.

Reference:

Goandal, N.F., Jemec, G.B.E. and Saunte, D.M.L. (2025), Botulinum toxin type A efficacy on pain and suppuration in hidradenitis suppurativa. J Eur Acad Dermatol Venereol. https://doi.org/10.1111/jdv.20611.