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 treatment modalities exist for solitary hidrocystomas including simple excision, electrodesiccation, and CO2 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 scarring without significant clinical improvement. Initially, incision and drainage was performed with flattening of the cysts; however, the cystic nodules refilled 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 flattening 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.