Clinical Health Updates

Botulinum toxin A effective for axillary hyperhidrosis

Clinical Question:
Are botulinum toxin type A injections safe and effective in the management of adults with axillary hyperhidrosis?

Bottom Line:
Botulinum toxin type A (Botox) injections are safe and effective for the treatment of adults with axillary hyperhidrosis. The duration of effect in this study was approximately 200 days.

Reference:
Lowe NJ, Glaser DA, Eadie N, et al, for the North American Botox in Primary Axillary Hyperhidrosis Clinical Study Group. Botulinum toxin type A in the treatment of primary axillary hyperhidrosis: A 52-week multicenter double-blind, randomized, placebo-controlled study of efficacy and safety. J Am Acad Dermatol 2007;56:604-611.

Study Design:
Randomized controlled trial (double-blinded)

Synopsis:
The long-term effects of botulinum toxin type A (BoNTA) on the global impairment associated with severe primary axillary hyperhidrosis have not been comprehensively assessed relative to placebo. The authors assessed the efficacy and safety of 2 dosages of BoNTA compared with placebo in subjects with primary axillary hyperhidrosis. Subjects (N = 322) were randomized to the use of BoNTA (75 U or 50 U/axilla) or placebo in this 52-week, multicenter, double-blind study. BoNTA treatment significantly reduced daily activity limitations at 4 weeks after injection. A 2-point improvement on the 4-point Hyperhidrosis Disease Severity Scale (HDSS) was reported in 75% of subjects in the 75-U and 50-U BoNTA groups and in 25% of the placebo group (P < .001). Improvements in HDSS scores were corroborated by gravimetric results. The median duration of effect was 197 days, 205 days, and 96 days in the 75-U, 50-U, and placebo groups, respectively. BoNTA was well tolerated.
LIMITATIONS: The effect of total surface area involvement on treatment efficacy was not evaluated.