Ethyl chloride spray for sensory relief for botulinum toxin injections of the hands and feet.

Botulinum toxin injections are effective in the treatment of palmar and plantar hyperhidrosis, but discomfort has limited its use. To study the use of ethyl chloride medium-stream spray in reducing injection discomfort. We used ethyl chloride medium-stream spray, in conjunction with precooling by frozen ice packs, in our No Sweat Clinic for our most recent 51 consecutive cases of botulinum toxin injection. Ethyl chloride spray greatly facilitated the injection procedure, and all patients completed the injections without hesitation or delay. Ethyl chloride medium-stream spray, in conjunction with precooling by frozen ice packs, is highly effective in reducing painful injection sensations. Its use is safe, economical, and easy to learn and does not require special equipment.