Local injection of botulinum toxin A for palmar hyperhidrosis: Usefulness and efficacy in relation to severity

Abstract

Botulinum toxin A is widely used in Europe and the USA for the treatment of localized hyperhidrosis, and its efficacy has been recognized. In this study, botulinum toxin A (Botox) was locally injected at 30 sites (2 U/injection) on the right palm in 27 patients with palmar hyperhidrosis (14 severe patients, 13 mild patients), and the results confirmed the efficacy of injection. The amount of sweat was then quantified for the left and right hands every month after local injection. The quantity of sweat on the treated hand was approximately one-fifth that on the untreated hand. In addition, the quantity of sweat on the untreated hand decreased slightly. Over time, the quantity of sweat on the treated hand increased slightly, but the quantity of sweat on the treated hand at 6 months after injection was less than half that before injection, and there were significant differences before and after injection. In the present study, severe sweating was defined as 1 mg/cm2/min or more and mild sweating as less than 1 mg/cm2/min, and the therapeutic effects of botulinum toxin A were analyzed in relation to severity. When compared to the mild cases, the quantity of sweat remained higher in the severe cases after botulinum toxin A therapy. Therefore, to achieve satisfactory effects in severe cases, it would be necessary to increase the number of injection sites, as well as injection dose.

Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis

“…41,42,68,72,88,91,147,154 It is not always feasible to blind patients in studies comparing minor surgical interventions with non-surgical interventions, or minor surgical interventions with more major surgery; such studies were considered to have a high overall risk of bias, owing to the potential effect on outcomes, many of which are subjective. Blinding of care providers was reported in only 12 studies; 37,57,69,[73][74][75][76][77][82][83][84][85] in 21 studies it was clear that care providers were not blinded, 21,[25][26][27][28]38,40,43,44,72,80,81,[88][89][90]92,[147][148][149][150]154 and in 16 studies it was unclear whether or not care providers were blinded. 24,29,41,42,51,53,59,60,68,71,…”

“…Studies were conducted in a range of different countries: 23 studies were conducted in European countries [Germany (n = 9 25,68,69,75,89,148,150,154,155 ), the UK (n = 2 91,184 ), Denmark (n = 2 37,149 ), Austria (n = 2 84,85 ), Poland (n = 1 ) and multiple European countries (n = 3 24,79,80 )], 15 studies were conducted in the Americas [USA (n = 13 21,26,27,29,42,53,71,73,74,76,77,82 ) and Brazil (n = 2 57,60 )], 11 studies were conducted in Asian countries [Japan (n = 4 41,83,90,185 ), South Korea (n = 3 43,44,51 ), Turkey (n = 2 39,40 ), India (n = 1 88 ) and Iran (n = 1 28 )] and one study was conducted in Australia. 38 Therefore, many of the study populations may not be representative of hyperhidrosis patients in the UK, because of the differences in climate.…”

“…38,41 All the studies of curettage, laser epilation, fractionated microneedle radiofrequency, microwave and ultrasound included only patients with axillary hyperhidrosis. All studies of BTX included patients with hyperhidrosis of the axilla except for seven 74,76,81,84,88,90,92 that studied plantar hyperhidrosis. Studies of topical glycopyrrolate included patients with hyperhidrosis of the axilla 53,91 or forehead.…”

“…Twenty-four studies reported blinding of participants to treatment group, [27][28][29]37,38,40,51,53,57,59,60,69,71,[73][74][75][76][77]79,[82][83][84][85] in 17 studies participants were not blinded, 21,[24][25][26]43,80,81,89,90,92,[148][149][150]155,184,185 and in eight studies it was unclear whether or not participants were blinded. 41,42,68,72,88,91,147,154 It is not always feasible to blind patients in studies comparing minor surgical interventions with non-surgical interventions, or minor surgical interventions with more major surgery; such studies were considered to have a high overall risk of bias, owing to the potential effect on outcomes, many of which are subjective.…”

“…It was clear that the allocation sequence was adequately generated in only eight RCTs; 21,51,59,69,75,76,79,83 methods of sequence generation were unclear in the other 24 RCTs. [24][25][26][27]29,37,41,42,53,57,60,68,[71][72][73][74]77,82,84,85,88,147,150 Seventeen studies were non-RCTs; 28,38,40,43,44,80,81,[89][90][91][92]148,149,154,155,184,185 therefore, there was no randomised sequence generation. Concealment of allocation was also poorly reported; only two RCTs reported adequate methods, and methods were unclear in the remaining 30 RCTs.…”