Botulinum toxin is widely used for cosmetic wrinkle reduction, hyperhidrosis, chronic migraine and facial muscle disorders, but concerns persist regarding adverse effects related to injection technique, toxin diffusion and practitioner variability. Therefore, it is of interest to evaluate the complication rates of community-based botulinum toxin therapy and characterize the clinical presentations of its associated adverse effects. A prospective pharmacological observational study was conducted on 120 patients receiving botulinum toxin type A injections. Majority of complications were mild and transient, with injection-site pain and bruising representing the most common local adverse effects. Thus, data shows the botulinum toxin injections performed by trained practitioners have a favorable safety profile in community practice.

Acral injections for conditions such as palmoplantar hyperhidrosis are associated with significant procedural pain, frequently limiting their use in pediatric populations. While nerve blocks, cryoanalgesia, and topical anesthetics can mitigate discomfort during palmar injections, each has practical limitations. This report describes a multimodal technique combining cryoanalgesia, pressure, and vibration using a handheld massager that substantially reduces injection-related pain and patient distress.

Complex regional pain syndrome is a refractory disease characterized by complex pathogenesis，severe chronic pain，and autonomic nervous system dysfunction.This article reports a 26-year-old female patient who presented with severe，electric shock-like pain and hyperalgesia in the first toes of both feet following an ankle sprain.In addition，her symptoms included localized redness，swelling，burning sensation，and hyperhidrosis.She was clinically diagnosed with complex regional pain syndrome.After oral pharmacotherapy for neuropathic pain proved ineffective，she was treated with ultrasound-guided pulsed radiofrequency of the medial plantar nerve combined with platelet-rich plasma injection.Postoperative follow-up showed progressive symptom alleviation.One month after the procedure，the pain score decreased to 0，and autonomic symptoms such as local redness，swelling，and abnormal sweating were completely resolved.No recurrence was observed during the six-month postoperative follow-up period.

Background: Primary plantar hyperhidrosis is a disabling condition characterized by excessive plantar sweating and impaired quality of life. Lumbar sympathectomy is reserved for patients with symptoms refractory to conservative treatment, but minimally invasive techniques remain technically heterogeneous. This study describes a modified retroperitoneoscopic lumbar sympathectomy and reports its preliminary perioperative outcomes. Methods: A single-center case series included consecutive patients who underwent modified retroperitoneoscopic lumbar sympathectomy for primary plantar hyperhidrosis between June 2019 and May 2024. The technique combined ultrasound-guided retroperitoneal access, indocyanine green (ICG)-assisted creation of the retroperitoneal working space, and temporary selective clamping of the lumbar sympathetic trunk with an intraoperative assessment of plantar temperature and perfusion before definitive clipping. Results: Forty-five patients underwent 81 procedures, including 35 bilateral procedures (70 sides), 10 unilateral procedures, and one unilateral reoperation for recurrent symptoms. All patients resumed oral intake and ambulation on the day of surgery and were discharged within 24 h according to institutional protocol. No intraoperative or postoperative complications were observed and resolution of plantar sweating in subsequent follow-ups was achieved. Conclusions: Modified retroperitoneoscopic lumbar Sympathetic Chain Selective Clamping appears to be a feasible and safe technique for the surgical treatment of primary plantar hyperhidrosis. These technical refinements may facilitate retroperitoneal access and intraoperative confirmation of the target sympathetic level. Larger comparative studies with standardized outcomes and longer follow-up are needed to confirm the durability and clinical value of this approach.

Eccrine angiomatous hamartoma is an uncommon benign cutaneous hamartoma characterized by proliferation of eccrine and vascular components. It usually presents at birth or in childhood as a solitary extremity lesion and may be associated with pain, tenderness, hypertrichosis, or hyperhidrosis. We report a 6-year-old boy with a recurrent warm, hyperhidrotic subcutaneous tumor on the lateral aspect of the right ankle. The lesion had previously been excised under the clinical impression of hemangioma and was reported as angiolipoma, but later recurred and enlarged. Clinical examination showed a flesh-colored 5 × 4.5 cm tumor with clear surface secretion. Qualitative infrared thermography demonstrated focal surface warmth over the lesion. Histopathology showed well-circumscribed unencapsulated dermal and subcutaneous nodules composed of proliferating eccrine glands, vascular channels, mucinous stroma, mature fat, dilated sweat ducts, and large vessels with organizing thrombus, confirming eccrine angiomatous hamartoma. In this case, infrared thermography converted clinically perceived warmth into a visible, non-contact surface map that may help localize symptomatic surface involvement when planning conservative excision. Histopathology remains essential for diagnosis.