Delivery of BotoxR by iontophoresis

Abstract

Conflict of interest: None declared. Sir, I read with great interest the case report by Kavanagh and Shams,1 in which Botox was administered by iontophoresis to two patients. My practice is devoted solely to treating patients with hyperhidrosis with Botox, so I believe I have a good perspective to comment on this article. As someone who is a Board Certified Anaesthesiologist and who uses a Bier block for regional anaesthesia, an easily learned and safe technique, I must take issue with the repeated comments by Kavanagh et al. about ‘painful injections’ when giving Botox injections. With a tourniquet applied at the wrist and 12–15 mL of 0·5% xylocaine, a very safe amount, the 50 or so injections can be made virtually pain free. Also, with a properly administered ulnar, median and radial wrist block, adequate anaesthesia can be obtained as well. I think the common method of some practitioners of using ice to numb the hands is as barbaric as using no anaesthesia at all.