Comparative study of efficacy and safety of botulinum toxin a injections and subcutaneous curettage in the treatment of axillary hyperhidrosis

Abstract

Background:Primary focal axillary hyperhidrosis is a chronic distressing disorder affecting both the sexes. When the condition is refractory to conservative management, we should go for more promising therapies like intradermal botulinum toxin A (BtxA) injections in the axilla, and surgical therapies like subcutaneous curettage of sweat glands.Aims and Objectives:The aim of this study is to compare the efficacy, safety and duration of action of intradermal BtxA injections in one axilla and subcutaneous curettage of sweat glands in the other axilla of the same patient with axillary hyperhidrosis.Materials and Methods:Twenty patients (40 axillae) received intradermal BtxA injections on the right side (20 axillae) and underwent tumescent subcutaneous curettage of sweat glands on the left side (20 axillae). Sweat production rate was measured using gravimetry analyses at baseline and at 3 months after the procedure. Subjective analyses were done using hyperhidrosis disease severity scale (HDSS) score at baseline, at 3rd and 6th month after the procedure.Results:At 3 months post-treatment, the resting sweat rate in the toxin group improved by 80.32% versus 79.79% in the subcutaneous curettage method (P = 0.21). Exercise-induced sweat rate in the toxin group improved by 88.76% versus 88.8% in the subcutaneous curettage group (P = 0.9). There was a significant difference in the HDSS score after treatment with both the modalities. There were no adverse events with BtxA treatment compared to very minor adverse events with the surgical method.Conclusion:Both intradermal BtxA injections and tumescent subcutaneous curettage of sweat glands had a significant decrease in the sweat rates with no significant difference between the two modalities. Hence, in resource poor settings where affordability of BtxA injection is a constraint, subcutaneous curettage of sweat glands can be preferred which has been found equally effective with no or minimal adverse events.

A systematic evidence-based review of treatments for primary hyperhidrosis

“…Efficacy, quality of life, and patient satisfaction were rated as “borderline” to “moderate”; safety was rated as having “low” SOE. There is sufficient evidence to conclude that liposuction curettage for the treatment of axillary hyperhidrosis is effective in reducing sweat production by 30% to over 80% for 6 months or more 25 , 29 , 37 . There is insufficient evidence to draw conclusions regarding long-term safety of subcutaneous curettage for the treatment of axillary hyperhidrosis but limited short-term evidence suggests that patients should expect to experience axillary discomfort, soreness or pain.…”

“…Specifically, two studies in axillary hyperhidrosis 25 , 26 were both rated at “moderate” RoB and with large response rates. Another axillary study 17 was obtained from Wade et al.…”

“…Liposuction curettage is performed at the dermal–subcutaneous interface using a liposuction device and a sharp, rasping-type cannula to damage the sweat glands. Three studies evaluating curettage were included in the present analysis 29 , 25 , 37 ( Table 4 ), two of which were comparator studies of curettage and botulinum toxin 29 , 25 (studies also are included in Table 3 for botulinum toxin arm). Efficacy, quality of life, and patient satisfaction were rated as “borderline” to “moderate”; safety was rated as having “low” SOE.…”

New trends in botulinum toxin use in dermatology

“…In detail, BoNT has been compared to other available treatment modalities. Treatment options should be carefully evaluated and selected for each patient [ 7 , 12 – 16 ]. However, BoNT has been proven to be effective in reducing the severity of HH and to improve quality of life (QoL) of HH patients.…”

“…The most recognized mechanism of action of BoNTs is the inhibition of neurotransmitters (acetylcholine, norepinephrine, substance P, calcitonin gene-related peptide [CGRP], and glutamate) release at the presynaptic neuromuscular junction. However, BoNTs can affect both sympathetic and parasympathetic functionality since acetylcholine is also a neurotransmitter of the autonomic nervous system [ 7 ]. Furthermore, recent evidence shows the effect of BoNTs on different human cell types, both neuronal and non-neuronal cells.…”