Evidence for effectiveness of botulinum toxin for hyperhidrosis

Summary

Hyperhidrosis refers to excessive and uncontrollable sweating beyond that is required to return body temperature to normal. Although a broad spectrum of treatment modalities are available including topical and systemic therapies, iontophoresis, and surgical interventions, their efficacy are usually short-term or are associated with unacceptable side effects.

Recently, chemodenervation using botulinum toxin has emerged as a safe and effective treatment for both primary palmar and axillary hyperhidrosis in several clinical trials. In this article, we utilized the scale developed by the Therapeutics and Technology Assessment (TTA) subcommittee of the American Academy of Neurology evaluating current evidence supporting the use of botulinum toxin for the treatment of primary focal hyperhidrosis. As a result, there is a strong evidence to support the efficacy of botulinum toxin type A in axillary (Level A evidence) and palmar (Level B evidence) hyperhidrosis.

This is a preview of subscription content, log in to check access.

References

  1. L Baumann A Slezinger M Halem J Vujevich K Mallin C Charles et al. (2005) ArticleTitleDouble-blind, randomized, placebo-controlled pilot study of the safety and efficacy of Myobloc (botulinum toxin type B) for the treatment of palmar hyperhidrosis Dermatol Surg 31 263–270 Occurrence Handle15841624 Occurrence Handle1:CAS:528:DC%2BD28XhtFyhu7nN Occurrence Handle10.1111/j.1524-4725.2005.31071

    PubMed  CAS  Article  Google Scholar 

  2. R Bhidayasiri DD Truong (2005) ArticleTitleExpanding use of botulinum toxin J Neurol Sci 235 1–9 Occurrence Handle15990116 Occurrence Handle10.1016/j.jns.2005.04.017 Occurrence Handle1:CAS:528:DC%2BD2MXmsVOru7o%3D

    PubMed  Article  CAS  Google Scholar 

  3. C Braune F Erbguth F Birklein (2001) ArticleTitleDose thresholds and duration of the local anhidrotic effect of botulinum toxin injections: measured by sudometry Br J Dermatol 144 111–117 Occurrence Handle11167691 Occurrence Handle10.1046/j.1365-2133.2001.03961.x Occurrence Handle1:CAS:528:DC%2BD3MXhtl2itLg%3D

    PubMed  Article  CAS  Google Scholar 

  4. KO Bushara DM Park JC Jones HS Schutta (1996) ArticleTitleBotulinum toxin – a possible new treatment for axillary hyperhidrosis Clin Exp Dermatol 21 276–278 Occurrence Handle8959898 Occurrence Handle10.1111/j.1365-2230.1996.tb00093.x Occurrence Handle1:STN:280:DyaK2s7hvFSktw%3D%3D

    PubMed  Article  CAS  Google Scholar 

  5. A Campanati L Penna T Guzzo et al. (2003) ArticleTitleQuality-of-life assessment in patients with hyperhidrosis before and after treatment with botulinum toxin: results of an open-label study Clin Ther 25 298–308 Occurrence Handle12637128 Occurrence Handle10.1016/S0149-2918(03)90041-5

    PubMed  Article  Google Scholar 

  6. WP Cheshire (1996) ArticleTitleSubcutaneous botulinum toxin type A inhibits regional sweating: an individual observation Clin Auton Res 6 123–124 Occurrence Handle8726099 Occurrence Handle10.1007/BF02291235 Occurrence Handle1:STN:280:DyaK28zjvVChuw%3D%3D

    PubMed  Article  CAS  Google Scholar 

  7. Edlund W, Gronseth G, So Y, Franklin G (2004) Subcommittee for the Quality Standards Subcommittee and the Therapeutics and Technology Assessment Subcommittee. Clinical Practice Guideline Process Manual. American Academy of Neurology, Minneapolis

  8. DA Glaser (2004) ArticleTitleTreatment of axillary hyperhidrosis by chemodenervation of sweat glands using botulinum toxin type A J Drugs Dermatol 3 627–631 Occurrence Handle15624745

    PubMed  Google Scholar 

  9. H Hamm MK Naumann JW Kowalski S Kutt C Kozma C Teale (2006) ArticleTitlePrimary focal hyperhidrosis: disease characteristics and functional impairment Dermatology 212 343–353 Occurrence Handle16707884 Occurrence Handle10.1159/000092285

    PubMed  Article  Google Scholar 

  10. M Heckmann AO Ceballos-Baumann G Plewig (2001) ArticleTitleBotulinum toxin A for axillary hyperhidrosis (excessive sweating) N Engl J Med 344 488–493 Occurrence Handle11172190 Occurrence Handle10.1056/NEJM200102153440704 Occurrence Handle1:CAS:528:DC%2BD3MXhtlKnsLo%3D

    PubMed  Article  CAS  Google Scholar 

  11. M Heckmann B Teichmann BM Pause G Plewig (2003) ArticleTitleAmelioration of body odor after intracutaneous axillary injection of botulinum toxin Arch Dermatol 139 57–59 Occurrence Handle12533165 Occurrence Handle10.1001/archderm.139.1.57 Occurrence Handle1:CAS:528:DC%2BD3sXhtVGgtrs%3D

    PubMed  Article  CAS  Google Scholar 

  12. J Hornberger K Grimes M Naumann InstitutionalAuthorNamefor the Multi-specialty Working Group on the Recognition, Diagnosis, and Treatment of Primary Focal Hyperhidrosis et al. (2004) ArticleTitleRecognition, diagnosis, treatment of primary focal hyperhidrosis J Am Acad Dermatol 51 274–286 Occurrence Handle15280848 Occurrence Handle10.1016/j.jaad.2003.12.029

    PubMed  Article  Google Scholar 

  13. T Karamfilov H Konrad K Karte U Wollina (2000) ArticleTitleLower relapse rate of botulinum toxin A therapy for axillary hyperhidrosis by dose increase Arch Dermatol 136 487–490 Occurrence Handle10768647 Occurrence Handle10.1001/archderm.136.4.487 Occurrence Handle1:CAS:528:DC%2BD3cXjtVyqsrw%3D

    PubMed  Article  CAS  Google Scholar 

  14. Kowalski JW, Eadie N, Daggett S, et al (2004) Validity and reliability of the hyperhidrosis disease severity scale (HDSS). The 62nd Annual Meeting of the American Academy of Dermatology, Washington, DC

  15. W Lear E Kessler N Solish DA Glaser (2007) ArticleTitleAn epidemiological study of hyperhidrosis Dermatol Surg 33 S69–S75 Occurrence Handle17241417 Occurrence Handle10.1111/j.1524-4725.2006.32334.x Occurrence Handle1:CAS:528:DC%2BD2sXjvVSht70%3D

    PubMed  Article  CAS  Google Scholar 

  16. PJ Lillis WPI Coleman (1990) ArticleTitleLiposuction for treatment of axillary hyperhidrosis Dermatol Clin 8 479–482 Occurrence Handle2199108 Occurrence Handle1:STN:280:DyaK3czjs1Wktg%3D%3D

    PubMed  CAS  Google Scholar 

  17. T Lin N Wang L Huang (2001) ArticleTitlePitfalls and complication avoidance associated with transthoracic endoscopic sympathectomy for primary hyperhidrosis (analysis of 2200 cases) Int J Surg Invest 2 377–385 Occurrence Handle1:STN:280:DC%2BD3s7mtFeisA%3D%3D

    CAS  Google Scholar 

  18. N Lowe A Campanati I Bodokh S Cliff P Jaen O Kreyden et al. (2004) ArticleTitleThe place of botulinum toxin type A in the treatment of focal hyperhidrosis Br J Dermatol 151 1115–1122 Occurrence Handle15606505 Occurrence Handle10.1111/j.1365-2133.2004.06317.x Occurrence Handle1:CAS:528:DC%2BD2MXnvV2rsw%3D%3D

    PubMed  Article  CAS  Google Scholar 

  19. NJ Lowe PS Yamauchi GP Lask R Patnaik S Iyer (2002) ArticleTitleEfficacy and safety of botulinum toxin type a in the treatment of palmar hyperhidrosis: a double-blind, randomized, placebo-controlled study Dermatol Surg 28 822–827 Occurrence Handle12269876 Occurrence Handle10.1046/j.1524-4725.2002.02039.x

    PubMed  Article  Google Scholar 

  20. NJ Lowe DA Glaser N Eadie S Daggett JW Kowalski PY Lai (2007) ArticleTitleBotulinum 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 56 604–611 Occurrence Handle17306417 Occurrence Handle10.1016/j.jaad.2007.01.009

    PubMed  Article  Google Scholar 

  21. M Naumann (2001) ArticleTitleEvidence-based medicine: botulinum toxin in focal hyperhidrosis J Neurol 248 IssueIDSuppl 1 31–33 Occurrence Handle11357238 Occurrence Handle10.1007/PL00007817 Occurrence Handle1:CAS:528:DC%2BD3MXosVenur0%3D

    PubMed  Article  CAS  Google Scholar 

  22. M Naumann P Flachenecker EB Brocker KV Toyka K Reiners (1997) ArticleTitleBotulinum toxin for palmar hyperhidrosis Lancet 349 252 Occurrence Handle9014916 Occurrence Handle10.1016/S0140-6736(05)64861-1 Occurrence Handle1:STN:280:DyaK2s7mslahtQ%3D%3D

    PubMed  Article  CAS  Google Scholar 

  23. M Naumann NJ Lowe (2001) ArticleTitleBotulinum toxin type A in treatment of bilateral primary axillary hyperhidrosis: randomised, parallel group, double blind, placebo controlled trial BMJ 323 596–599 Occurrence Handle11557704 Occurrence Handle10.1136/bmj.323.7313.596 Occurrence Handle1:CAS:528:DC%2BD3MXnslSlsbg%3D

    PubMed  Article  CAS  Google Scholar 

  24. M Naumann NJ Lowe CR Kumar H Hamm (2003) ArticleTitleBotulinum toxin type a is a safe and effective treatment for axillary hyperhidrosis over 16 months: a prospective study Arch Dermatol 139 731–736 Occurrence Handle12810503 Occurrence Handle10.1001/archderm.139.6.731 Occurrence Handle1:CAS:528:DC%2BD3sXlsVamuro%3D

    PubMed  Article  CAS  Google Scholar 

  25. MK Naumann H Hamm NJ Lowe (2002) ArticleTitleEffect of botulinum toxin type A on quality of life measures in patients with excessive axillary sweating: a randomized controlled trial Br J Dermatol 147 1218–1226 Occurrence Handle12452874 Occurrence Handle10.1046/j.1365-2133.2002.05059.x Occurrence Handle1:CAS:528:DC%2BD3sXksV2msA%3D%3D

    PubMed  Article  CAS  Google Scholar 

  26. IR Odderson (2002) ArticleTitleLong-term quantitative benefits of botulinum toxin type A in the treatment of axillary hyperhidrosis Dermatol Surg 28 480–483 Occurrence Handle12081675 Occurrence Handle10.1046/j.1524-4725.2002.01252.x

    PubMed  Article  Google Scholar 

  27. TM Proebstle V Schneiders J Knop (2002) ArticleTitleGravimetrically controlled efficacy of sucorial curettage: a prospective study for treatment of axillary hyperhidrosis Dermatol Surg 28 1022–1026 Occurrence Handle12460297 Occurrence Handle10.1046/j.1524-4725.2002.02104.x Occurrence Handle1:STN:280:DC%2BD38npvFWhug%3D%3D

    PubMed  Article  CAS  Google Scholar 

  28. PM Quinton (1983) ArticleTitleSweating and its disorders Ann Rev Med 34 429–520 Occurrence Handle6344770 Occurrence Handle10.1146/annurev.me.34.020183.002241 Occurrence Handle1:STN:280:DyaL3s3ivFGhuw%3D%3D

    PubMed  Article  CAS  Google Scholar 

  29. S Reinauer A Neusser G Schauf E Holzle (1993) ArticleTitleIontophoresis with alternating current and direct current offer (AC/DC iontophoresis): a new approach for the treatment of hyperhidrosis Br J Dermatol 129 166–169 Occurrence Handle7654577 Occurrence Handle10.1111/j.1365-2133.1993.tb03521.x Occurrence Handle1:STN:280:DyaK2MzotlWkug%3D%3D

    PubMed  Article  CAS  Google Scholar 

  30. KM Ro RM Cantor KL Lange SS Ahn (2002) ArticleTitlePalmar hyperhidrosis: evidence of genetic transmission J Vasc Surg 35 382–386 Occurrence Handle11854739 Occurrence Handle10.1067/mva.2002.119507

    PubMed  Article  Google Scholar 

  31. R Rompel S Scholz (2001) ArticleTitleSubcutaneous curettage vs injection of botulinum toxin A for treatment of axillary hyperhidrosis J Eur Acad Dermatol Venereol 15 207–211 Occurrence Handle11683282 Occurrence Handle10.1046/j.1468-3083.2001.00226.x Occurrence Handle1:STN:280:DC%2BD3MngvV2muw%3D%3D

    PubMed  Article  CAS  Google Scholar 

  32. D Saadia A Voustianiouk AK Wang H Kaufmann (2001) ArticleTitleBotulinum toxin type A in primary palmar hyperhidrosis: randomized, single-blind, two-dose study Neurology 57 2095–2099 Occurrence Handle11739832 Occurrence Handle1:CAS:528:DC%2BD38XivVyjtg%3D%3D

    PubMed  CAS  Google Scholar 

  33. K Sato WH Kang K Saga KT Sato (1989a) ArticleTitleBiology of sweat glands and their disorders. I. Normal sweat gland function J Am Acad Dermatol 20 537–563 Occurrence Handle1:STN:280:DyaL1M3jsVOjsA%3D%3D

    CAS  Google Scholar 

  34. K Sato WH Kang K Saga KT Sato (1989b) ArticleTitleBiology of sweat glands and their disorders. II. Disorders of sweat gland function J Am Acad Dermatol 20 713–726 Occurrence Handle1:STN:280:DyaL1M3jsVOmsw%3D%3D Occurrence Handle10.1016/S0190-9622(89)70081-5

    CAS  Article  Google Scholar 

  35. M Simonetta Moreau C Cauhepe JP Magues JM Senard (2003) ArticleTitleA double-blind, randomized, comparative study of Dysport vs. Botox in primary palmar hyperhidrosis Br J Dermatol 149 1041–1045 Occurrence Handle14632812 Occurrence Handle10.1111/j.1365-2133.2003.05620.x Occurrence Handle1:STN:280:DC%2BD3srltlKjtA%3D%3D

    PubMed  Article  CAS  Google Scholar 

  36. N Solish A Benohanian JW Kowalski (2005) ArticleTitleHyperhidrosis obotCDSGoH-RQoLiPA. Prospective open-label study of botulinum toxin type A in patients with axillary hyperhidrosis: effects on functional impairment and quality of life Dermatol Surg 31 405–413 Occurrence Handle15871315 Occurrence Handle1:CAS:528:DC%2BD2sXit1Whuw%3D%3D Occurrence Handle10.1111/j.1524-4725.2005.31106

    PubMed  CAS  Article  Google Scholar 

  37. LP Stolman (1998) ArticleTitleTreatment of hyperhidrosis Dermatol Clin 16 863–867 Occurrence Handle9891696 Occurrence Handle10.1016/S0733-8635(05)70062-0 Occurrence Handle1:STN:280:DyaK1M7gvVyntw%3D%3D

    PubMed  Article  CAS  Google Scholar 

  38. DR Strutton JW Kowalski DA Glaser PE Stang (2004) ArticleTitleUS prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey J Am Acad Dermatol 51 241–248 Occurrence Handle15280843 Occurrence Handle10.1016/j.jaad.2003.12.040

    PubMed  Article  Google Scholar 

  39. C Swartling H Naver M Lindberg (2001) ArticleTitleBotulinum A toxin improves life quality in severe primary focal hyperhidrosis Eur J Neurol 8 247–252 Occurrence Handle11328333 Occurrence Handle10.1046/j.1468-1331.2001.00207.x Occurrence Handle1:STN:280:DC%2BD3MzntVyksA%3D%3D

    PubMed  Article  CAS  Google Scholar 

  40. S Talarico-Filho M Mendonca do Nascimento F Sperandeo de Macedo C de Sanctis Pecora (2007) ArticleTitleA double-blind, randomized, comparative study of two type A botulinum toxins in the treatment of primary axillary hyperhidrosis Dermatol Surg 33 S44–S50 Occurrence Handle17241414 Occurrence Handle10.1111/j.1524-4725.2006.32331.x Occurrence Handle1:CAS:528:DC%2BD2sXjvVSht74%3D

    PubMed  Article  CAS  Google Scholar 

  41. SR Tan N Solish (2002) ArticleTitleLong-term efficacy and quality of life in the treatment of focal hyperhidrosis with botulinum toxin type A Dermatol Surg 28 495–499 Occurrence Handle12081678 Occurrence Handle10.1046/j.1524-4725.2002.01159.x

    PubMed  Article  Google Scholar 

  42. YR Tu X Li M Lin FC Lai YP Li JF Chen et al. (2007) ArticleTitleEpidemiological survey of primary palmar hyperhidrosis in adolescent in Fuzhou of People’s Republic of China Eur J Cardiothorac Surg 31 737–739 Occurrence Handle17314049 Occurrence Handle10.1016/j.ejcts.2007.01.020

    PubMed  Article  Google Scholar 

  43. JE Ware M Kosinski SD Keller (1996) ArticleTitleA 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity Med Care 34 220–233 Occurrence Handle8628042 Occurrence Handle10.1097/00005650-199603000-00003

    PubMed  Article  Google Scholar 

  44. J Zacherl ER Huber M Imhof et al. (1998) ArticleTitleLong-term results of 630 thoracoscopic sympathectomies for primary hyperhidrosis: the Viena experience Eur J Surg Suppl 580 43–46 Occurrence Handle9641386 Occurrence Handle10.1080/11024159850191148

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to R. Bhidayasiri.

Additional information

Correspondence: Roongroj Bhidayasiri, MRCP (UK), Chulalongkorn Comprehensive Movement Disorders Center, Division of Neurology, Chulalongkorn University Hospital, Bangkok 10330, Thailand

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bhidayasiri, R., Truong, D. Evidence for effectiveness of botulinum toxin for hyperhidrosis. J Neural Transm 115, 641–645 (2008). https://doi.org/10.1007/s00702-007-0812-7

Download citation

  • Keywords: Botulinum toxin; hyperhidriosis