Botulinum toxin as a treatment for social phobia with hyperidrosis

Abstract

BACKGROUND: Blushing, trembling, and sweating are frequently seen in social phobia. OBJECTIVES: In this study, we aimed at describing the response of a patient with a generalized type of social phobia and hyperhydrosis to cognitive-behavioral therapy augmented by botulinum toxin. METHOD: Single case report. RESULTS: Mr. A, a 20 year-old university student, sought treatment in our unit for social phobia with comorbid depression. Mr. A also exhibited a diagnosis of palmar, plantar, and axilar hyperidrosis. He described that exposure to feared situations always lead to aggravation of sweating and other symptoms of heightened physiological arousal. Both social phobia and hyperhydrosis had their onset in early adolescence, with the former beginning four years before the latter. Cognitive-behavioral therapy led to aliviation of depression but effective treatment of social phobia was only possible after therapy with botulinum toxin. DISCUSSION: Botulinum toxin, a treatment that blocks peripheral autonomic symptoms, might also lead to improvement of social phobia.