Onabotulinumtoxin A may be effective ‘for most cases’ of Hailey-Hailey disease

Key takeaways:

• Three of four patients with Hailey-Hailey disease treated with onabotulinumtoxin A showed 2-point reductions in disease severity scale.
• Reinjection at 4 weeks yielded 1-point improvement in disease severity.

Onabotulinumtoxin A was associated with significant improvement over placebo in Hailey-Hailey disease severity, according to findings from a small, single-center study.

“Hailey-Hailey disease (HHD) can be treated with topical steroids, antibiotics and invasive surgical procedures,” Ryan C. Saal, BS, of Eastern Virginia Medical School, and colleagues wrote. “Since sweating often exacerbates HHD lesions, the use of onabotulinumtoxin A could serve as an adjunctive treatment.”

In the double-blind, placebo-controlled study, patients with HHD were assessed for the safety and efficacy of onabotulinumtoxin A (Btx-A).

Four patients received the study drug and three were administered placebo initially, according to the findings. One patient in the placebo group exited the trial early.

All but one of the patients treated with Btx-A demonstrated a decrease of two levels on the 4-point clinical severity scale after 8 or 12 weeks of intervention.

One of the patients in the placebo arm maintained clearance of lesions for 6 months. However, two other patients in the placebo arm failed to demonstrate any improvement in target lesion areas. One of these patients exited the study early, whereas the other opted to receive an open-label Btx-A injection at the 4-week follow-up. This patient, in addition to the three patients from the Btx-A group who received reinjections of the study drug at the 4-week follow-up, experienced a decrease of at least one severity scale level at 8 or 12 weeks.

“Btx-A is a safe treatment that is effective for most cases of HHD,” Saal and colleagues concluded. “The most severe cases of HHD may not respond to Btx-A as sole treatment.”