Background Treatment of primary focal hyperhidrosis is oftenunsatisfactory. Botulinum toxin A can stop excessive sweatingby blocking the release of acetylcholine, which mediates sympatheticneurotransmission in the sweat glands.
Methods We conducted a multicenter trial of botulinum toxinA in 145 patients with axillary hyperhidrosis. The patientshad rates of sweat production greater than 50 mg per minuteand had had primary axillary hyperhidrosis that was unresponsiveto topical therapy with aluminum chloride for more than oneyear. In each patient, botulinum toxin A (200 U) was injectedinto one axilla, and placebo was injected into the other ina randomized, double-blind manner. (The units of the botulinumtoxin A preparation used in this study are not identical tothose of other preparations.) Two weeks later, after the treatmentswere revealed, the axilla that had received placebo was injectedwith 100 U of botulinum toxin A. Changes in the rates of sweatproduction were measured by gravimetry.
Results At base line, the mean (±SD) rate of sweat productionwas 192±136 mg per minute. Two weeks after the firstinjections the mean rate of sweat production in the axilla thatreceived botulinum toxin A was 24±27 mg per minute, ascompared with 144±113 mg per minute in the axilla thatreceived placebo (P<0.001). Injection of 100 U into the axillathat had been treated with placebo reduced the mean rate ofsweat production in that axilla to 32±39 mg per minute(P<0.001). Twenty-four weeks after the injection of 100 U,the rates of sweat production (in the 136 patients in whom therates were measured at that time) were still lower than base-linevalues, at 67±66 mg per minute in the axilla that received200 U and 65±64 mg per minute in the axilla that receivedplacebo and 100 U of the toxin. Treatment was well tolerated;98 percent of the patients said they would recommend this therapyto others.
Conclusions Intradermal injection of botulinum toxin A is aneffective and safe therapy for severe axillary hyperhidrosis.
Source Information
From the Department of Dermatology, Ludwig-Maximilians-Universität (M.H., G.P.), and the Department of Neurology, Technische Universität München (A.O.C.-B.) — both in Munich, Germany.
Address reprint requests to Dr. Heckmann at Dermatologische Klinik, Ludwig-Maximilians-Universität, Frauenlobstr. 9–11, 80337 Munich, Germany, or at heckmann{at}derma.med.uni-muenchen.de.
Naumann, M., So, Y., Argoff, C. E., Childers, M. K., Dykstra, D. D., Gronseth, G. S., Jabbari, B., Kaufmann, H. C., Schurch, B., Silberstein, S. D., Simpson, D. M.
(2008). Assessment: Botulinum neurotoxin in the treatment of autonomic disorders and pain (an evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology
70: 1707-1714
[Abstract][Full Text]
Rzany, B., Ascher, B., Fratila, A., Monheit, G. D., Talarico, S., Sterry, W., for the GLADYS Study Group,
(2006). Efficacy and safety of 3- and 5-injection patterns (30 and 50 u) of botulinum toxin a (dysport) for the treatment of wrinkles in the glabella and the central forehead region.. Arch Dermatol
142: 320-326
[Abstract][Full Text]
Heckmann, M., Plewig, G., for the Hyperhidrosis Study Group,
(2005). Low-Dose Efficacy of Botulinum Toxin A for Axillary Hyperhidrosis: A Randomized, Side-By-Side, Open-Label Study. Arch Dermatol
141: 1255-1259
[Abstract][Full Text]
Eisenach, J. H., Atkinson, J. L. D., Fealey, R. D.
(2005). Hyperhidrosis: Evolving Therapies for a Well-Established Phenomenon. Mayo Clin Proc.
80: 657-666
[Abstract]
Hassin-Baer, S., Scheuer, E., Buchman, A. S., Jacobson, I., Ben-Zeev, B.
(2005). Botulinum Toxin Injections for Children With Excessive Drooling. J Child Neurol
20: 120-123
[Abstract]
Haider, A., Solish, N.
(2005). Focal hyperhidrosis: diagnosis and management. CMAJ
172: 69-75
[Abstract][Full Text]
Jankovic, J
(2004). Botulinum toxin in clinical practice. J. Neurol. Neurosurg. Psychiatry
75: 951-957
[Abstract][Full Text]
Naumann, M., Lowe, N. J., Kumar, C. R., Hamm, H.
(2003). Botulinum Toxin Type A Is a Safe and Effective Treatment for Axillary Hyperhidrosis Over 16 Months: A Prospective Study. Arch Dermatol
139: 731-736
[Abstract][Full Text]
Gossot, D., Galetta, D., Pascal, A., Debrosse, D., Caliandro, R., Girard, P., Stern, J.-B., Grunenwald, D.
(2003). Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis. Ann. Thorac. Surg.
75: 1075-1079
[Abstract][Full Text]
Baumann, L. S., Halem, M. L.
(2003). Systemic Adverse Effects After Botulinum Toxin Type B (Myobloc) Injections for the Treatment of Palmar Hyperhidrosis. Arch Dermatol
139: 226-226
[Full Text]
Schmidt, J. J., Stafford, R. G.
(2003). Fluorigenic Substrates for the Protease Activities of Botulinum Neurotoxins, Serotypes A, B, and F. Appl. Environ. Microbiol.
69: 297-303
[Abstract][Full Text]
Heckmann, M., Teichmann, B., Pause, B. M., Plewig, G.
(2003). Amelioration of Body Odor After Intracutaneous Axillary Injection of Botulinum Toxin A. Arch Dermatol
139: 57-59
[Abstract][Full Text]
Bushara, M. A., Bushara, K., Heckmann, M., Plewig, G., Pause, B. M.
(2002). Botulinum Toxin, Sweating, and Body Odor. NEJM
347: 620-621
[Full Text]
Kreyden, O. P., Heckmann, M., Peschen, M.
(2002). Delusional Hyperhidrosis as a Risk for Medical Overtreatment: A Case of Botulinophilia. Arch Dermatol
138: 538-539
[Full Text]
Hund, M., Kinkelin, I., Naumann, M., Hamm, H.
(2002). Definition of Axillary Hyperhidrosis by Gravimetric Assessment. Arch Dermatol
138: 539-541
[Full Text]
Bhakta, B B, Roussounnis, S H
(2002). Treating childhood hyperhidrosis with botulinum toxin type A. Arch. Dis. Child.
86: 68-68
[Full Text]
Naumann, M, Lowe, N J
(2001). Botulinum toxin type A in treatment of bilateral primary axillary hyperhidrosis: randomised, parallel group, double blind, placebo controlled trial. BMJ
323: 596-596
[Abstract][Full Text]
(2001). Botulinum Toxin A for Axillary Hyperhidrosis: The Definitive Study. Journal Watch Dermatology
2001: 1-1
[Full Text]
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