Adjunctive Botulinum Toxin Type A for Bruxism and Sweat‐Worsened Facial Blistering in Recessive Dystrophic Epidermolysis Bullosa: A Case Series

ABSTRACT Patients with severe Recessive Dystrophic Epidermolysis Bullosa (RDEB) present facial contractures that hinder the delivery of standard treatment strategies such as occlusal splints for bruxism. Sweat‐induced facial blisters are painful and negatively affect the patient's quality of life. We present the preliminary outcomes of administering BTX‐A in the orofacial region in three patients with RDEB. Case 1, a 15‐year‐old female patient with severe RDEB, severe bruxism and severe microstomia, was first infiltrated with 50U of BTX‐A in the masseters. For the next 4 years, she received yearly infiltrations of BTX‐A, increasing the dosage from 50 to 100U and including the temporalis muscle into the infiltration scheme. Symptoms decreased after 48 h, maximal efficacy after 2 weeks, absence of bruxism‐related pain lasted 5 to 8 months. Patient‐reported outcome: the treatment reduced her daily pain and improved her quality of life significantly. Case 2, a 22‐year‐old male patient with severe RDEB, was treated for bruxism with 50U BTX‐A once, with complete remission of pain‐related symptoms. Case 3, a 19‐year‐old female patient with severe RDEB, was treated for bruxism‐related oral pain with 100U of BTX‐A on the masseters and temporalis. When returning to treatment, the patient reported that BTX‐A infiltrations improved her facial skin, reducing her sweat‐worsened blistering episode. She requested facial BTX‐A infiltration, which was applied over two consecutive years. Patient‐reported outcome: bruxism‐related pain was successfully treated after one BTX‐A infiltration; facial infiltrations reduced her sweat‐worsened facial blisters. She rates her treatment success score as 10/10, as her face is not burning anymore. BTX‐A infiltrations reduced bruxism‐triggered orofacial pain and facial sweat‐worsened blistering with minimal adverse effects. Botulinum toxin is a promising alternative for managing both bruxism in patients with severe microstomia and reducing sweat‐worsened facial blisters in severe RDEB. Further studies are needed to confirm these findings.