Effectiveness and safety of botulinum toxin A in the treatment of recalcitrant Hailey-Hailey disease in a multipathological patient

Hailey-Hailey disease (HHD) is a chronic, relapsing genodermatosis that is often difficult to treat, especially in elderly patients with multiple pathologies. We present the case of an 81-year-old woman with late-onset HHD, numerous comorbidities, and an incomplete response to several lines of topical and systemic treatment, including oral corticosteroid therapy. She was treated with botulinum toxin type A (BTA) in the submammary region. After one month, the patient showed significant clinical improvement, maintaining a complete response after 9 months of follow-up. Her good tolerance to treatment is noteworthy, allowing a significant reduction in the need for systemic corticosteroids. We consider BTA to be an effective and safe option, especially in patients resistant to other therapies and difficult to manage due to age or concomitant medical conditions.