Treatment for Multiple Periorbital Eccrine Hidrocystomas: Botulinum Toxin A

Hidrocystomas are relatively common cystic lesions that can display either apocrine or eccrine differentiation. While numerous treat- ment modalities exist for solitary hidrocystomas including simple excision, electrodesiccation, and CO 2 laser, treatment of multiple hidrocystomas can be challenging. A 38-year-old, black female with a 23-year history of multiple periorbital cystic nodules presented to the clinic with the complaint of lesions that were increasing in size and number. Prior treatment included excision resulting in scar- ring without signifi cant clinical improvement. Initially, incision and drainage was performed with fl attening of the cysts; however, the cystic nodules refi lled to baseline by 6 weeks. Subsequently, intralesional botulinum toxin type A was offered as an alternate therapy in conjunction with incision and drainage. The patient reported sustained fl attening of the lesions at both 1-month and 4-month follow-up appointments. Intralesional botulinum toxin A offers a novel treatment for patients with multiple hidrocystomas that have failed other therapies.