Subcutaneous curettage vs. injection of botulinum toxin A for treatment of axillary hyperhidrosis

Rompel, Rainer; Scholz, Stefan

doi:10.1046/j.1468-3083.2001.00226.x

Cited by 79 publications

(73 citation statements)

References 38 publications

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“…In the majority of comparative studies, the intervention was compared against a placebo/sham device or no treatment, although some studies compared two or more active treatments, such as BTX, compared with iontophoresis, 88,92 BTX compared with glycopyrrolate, 91 BTX compared with curettage, 21,148,155,184 curettage compared with laser epilation, 24 or curettage compared with more radical surgery. 149,150 Table 2 shows the comparisons made in the included comparative studies.…”

Section: Results Of the Clinical Effectiveness Reviewmentioning

confidence: 99%

“…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.…”

Section: Characteristics Of Studies Included In the Review Of Effectimentioning

confidence: 99%

“…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.…”

Section: Quality Of Studies Included In the Reviewmentioning

confidence: 99%

“…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.…”

Section: Quality Of Studies Included In the Reviewmentioning

confidence: 99%

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

Wade

Rice

Llewellyn

et al. 2017

Health Technol Assess

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BackgroundHyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable.ObjectiveTo establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care.MethodsA systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only.Results and conclusionsFifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life.LimitationsThe evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla.Future workBased on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses.Study registrationThis study is registered as PROSPERO CRD42015027803.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Results Of the Clinical Effectiveness Reviewmentioning

confidence: 99%

Section: Characteristics Of Studies Included In the Review Of Effectimentioning

confidence: 99%

Section: Quality Of Studies Included In the Reviewmentioning

confidence: 99%

Section: Quality Of Studies Included In the Reviewmentioning

confidence: 99%

See 2 more Smart Citations

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

Wade

Rice

Llewellyn

et al. 2017

Health Technol Assess

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“…Botulinum toksinin hiperhidrozda etki süresi yaklaşık 4-7 aydır. 3,4 Hastada tedavinin etkisi ortalamanın da üzerinde, 12 ay devam etti. Fokal hiperhidrozun yaşam kalitesini olumsuz yönde etkilediği, anksiyete, depresyon ve sosyal fobiye yol açabildiği bildirilmiştir.…”

Section: Discussionunclassified

Frontal Hiperhidrozda Botulinum Toksin Uygulaması

Aksu¹,

Saraçoğlu²,

Sabuncu³

2011

TURKDERM

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ÖzetFokal hiperhidroz sıklıkla aksiller ve palmoplantar bölgeye lokalizedir. Fakat daha az sıklıkla hiperhidroz alın bölgesinde de görü- Sum maryFocal hyperhidrosis is usually localized to the axillae, palms and soles. Less frequently, hyperhidrosis may be confined to the forehead and may have negative impact on patient's quality of life.A 34-year-old man presented to our clinic with the complaint of frontal hyperhidrosis. He was treated with botulinum toxin A. Thirty points were marked over the forehead and at each injection point, 0.15 ml (3U) botulinum toxin A were injected intracutaneously.Hyperhidrosis was significantly reduced and the effect lasted for 12 months. Skindex-29, a quality-of-life measure for skin disease, was administered to the patient at the beginning and at the end of second week of botulinum toxin A injection. There was a significant improvement on the Skindex-29 scale at the end of the treatment.There was no any side effect detected during and after the treatment. Botulinum toxin A treatment is considered to be effective and Gi riflFokal hiperhidroz sıklıkla aksiller ve palmoplantar bölgeye lokalizedir. Bazı erişkinlerde, özellikle erkeklerde, alında terleme görülebilir ve buna bağlı olarak hastanın yaşam kalitesi olumsuz yönde etkilenebilir. Olgu sunumuOtuz dört yaşında erkek hasta alında terleme şikayetiyle dermatoloji polikliniğine başvurdu. Hasta şikayetinin 10-12 yıldır mevcut olduğunu belirtti. Hastanın terlemesi stres, heyecan, fiziksel aktivite ve sıcakla birlikte artmaktaydı. Hasta terin gözüne damladı- Olgu SunumuCase Report

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Disorders of Sweat Glands

Coulson¹

2004

Rook's Textbook of Dermatology

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Subcutaneous curettage vs. injection of botulinum toxin A for treatment of axillary hyperhidrosis

Cited by 79 publications

References 38 publications

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

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

Frontal Hiperhidrozda Botulinum Toksin Uygulaması

Disorders of Sweat Glands

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