Five-year follow-up of patients treated with intra-dermal botulinum toxin for axillary hyperhidrosis

Abstract

Background

Axillary hyperhidrosis is a common complaint affecting 5% of the general population. It can significantly impact quality of life (QOL) and may be extremely debilitating. Administration of intra-dermal botulinum toxin type-A (Botox) has been proven to be effective in managing axillary hyperhidrosis; however, to date, no long-term data has assessed its efficacy.

Aim

We aim to assess long-term (> 5 years) QOL outcomes in this patient cohort.

Methods

In this single-centre series, all patients attending for axillary botox, with five or more years of follow-up, were prospectively included. QOL was assessed in all patients using the validated assessment tool, the modified Dermatology Life Quality Index (DLQI). Standard statistical methods were utilised with data reported as mean (± standard deviation). Subgroup analysis utilising previously published departmental data allowed for further assessment of change in QOL over time.

Results

A total of 75 patients (83% female) met the inclusion criteria with 67% completing the DLQI assessment. Follow-up ranged from 5 to 10 years with a mean age of 37.6 years (± 8.82). The mean number of treatments over the study period was 12 (± 3.1). Mean overall post-treatment DLQI score was 1.6 (± 2.01). This represented a significant improvement in patient QOL (p = < 0.0001) associated with long-term botox application. This statistical significance was identified consistently across all components of the DLQI tool.

Conclusion

These data suggest that the established early QOL benefits associated with intra-dermal botox administration for AH are sustained in the long term. This benefit was seen across all subsets of the DLQI tool.

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

References

  1. 1.

    Sammons J, Khachemoune A (2017) Axillary hyperhidrosis: a focused review. J Dermatolog Treat:582–590. https://doi.org/10.1080/09546634.2017.1309347

  2. 2.

    Rosen R, Stewart T (2018) Results of a 10-year follow-up study of botulinum toxin A therapy for primary axillary hyperhidrosis in Australia. Intern Med J 48:343–347. https://doi.org/10.1111/imj.13727

    Article  PubMed  Google Scholar 

  3. 3.

    Schick CH (2016) Pathophysiology of hyperhidrosis. Thorac Surg Clin NA 26(4):389–393. https://doi.org/10.1016/j.thorsurg.2016.06.002

    Article  Google Scholar 

  4. 4.

    S. Scamoni, L. Valdatta, C. Frigo, et al. (2012) Treatment of primary axillary hyperhidrosis with botulinum toxin type A : our experience in 50 patients from 2007 to 2010. Int. Sch. Res. Netw., vol. 2012. DOI: https://doi.org/10.5402/2012/702714

  5. 5.

    Campanati A, Penna L, Guzzo T et al (2003) Quality-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. https://doi.org/10.1016/S0149-2918(03)90041-5

    Article  PubMed  Google Scholar 

  6. 6.

    Naumann M, Hamm H, Lowe NJ (2002) Effect 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. https://doi.org/10.1046/j.1365-2133.2002.05059.x

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    J. P. Gibbons, E. Nugent, N. O’Donohoe et al. (2016) Experience with botulinum toxin therapy for axillary hyperhidrosis and comparison to modelled data for endoscopic thoracic sympathectomy a quality of life and cost effectiveness analysis. Surg., pp. 2–6. DOI: https://doi.org/10.1016/j.surge.2015.05.002

  8. 8.

    Glaser DA, Pariser DM, Hebert AA, Landells I, Somogyi C, Weng E, Brin MF, Beddingfield F (2015) A Prospective, nonrandomized , open-label study of the efficacy and safety of OnabotulinumtoxinA in adolescents with primary axillary hyperhidrosis. Pediatr Dermatol 32(5):609–617. https://doi.org/10.1111/pde.12620 A Prospective, Nonrandomized, Open-Label Study of the Efficacy and Safety of OnabotulinumtoxinA in Adolescents with Primary Axillary Hyperhidrosis

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    M. Naumann and N.J. Lowe (2001) Botulinum toxin type A in treatment of bilateral primary axillary hyperhidrosis: randomised, parallel group, double blind, placebo controlled trial. Br Med J, vol. 323, no. September, pp. 1–4. DOI: https://doi.org/10.1136/bmj.323.7313.596

  10. 10.

    Heckmann M, Ceballos-Baumann AO, Plewig G et al (2001) Botulinum toxin a for axillary hyperhidrosis (excessive sweating). N Engl J Med 344(7):488–493. https://doi.org/10.1056/NEJM200102153440704

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Doft MA, Kasten JL, Ascherman JA (2011) Treatment of axillary hyperhidrosis with botulinum toxin : a single surgeon’s experience with 53 consecutive patients. Aesthet Plast Surg (35):1079–1086. https://doi.org/10.1007/s00266-011-9738-4

  12. 12.

    Lewis V, Finlay AY (2004) 10 years experience of the Dermatology Life Quality Index ( DLQI ). J Investig Dermatology Symp Proc 9(2):169–180. https://doi.org/10.1111/j.1087-0024.2004.09113.x

    Article  Google Scholar 

  13. 13.

    Swartling C, Naver H, Lindberg M (2001) Botulinum A toxin improves life quality in severe primary focal hyperhidrosis. Eur J Neurol 8(3):247–252. https://doi.org/10.1046/j.1468-1331.2001.00207.x

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Lecouflet M, Leux C, Fenot M, Célerier P, Maillard H (2013) Duration of efficacy increases with the repetition of botulinum toxin A injections in primary axillary hyperhidrosis: a study in 83 patients. J Am Acad Dermatol 69(6):960–964. https://doi.org/10.1016/j.jaad.2013.08.002

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Brehmer F, Lockmann A, Gronemeyer L-L et al (2015) Repetitive injections of botulinum toxin A continuously increase the duration of efficacy in primary axillary hyperhidrosis: a retrospective analysis in 101 patients. J Dtsch Dermatol Ges 13(8):799–805. https://doi.org/10.1111/ddg.12623

    Article  PubMed  Google Scholar 

  16. 16.

    Strutton DR, Kowalski JW, Glaser DA, Stang PE (2004) US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey. J Am Acad Dermatol 51(2):241–248. https://doi.org/10.1016/j.jaad.2003.12.040

    Article  PubMed  Google Scholar 

  17. 17.

    O’Brien R, Hunt K, Hart G (2005) ‘It ’ s caveman stuff, but that is to a certain extent how guys still operate ’: men’s accounts of masculinity and help seeking. Soc Sci Med 61:503–516. https://doi.org/10.1016/j.socscimed.2004.12.008

    Article  PubMed  Google Scholar 

  18. 18.

    Dressler D, Adib Saberi F (2013) Towards a dose optimisation of botulinum toxin therapy for axillary hyperhidrosis : comparison of different Botox doses. J Neural Transm 120(11):1–3. https://doi.org/10.1007/s00702-013-1021-1

    CAS  Article  Google Scholar 

  19. 19.

    J. M. O. Riordan, E. Fitzgerald, C. Gowing et al. (2006) Topical local anaesthetic (tetracaine) reduces pain from botulinum toxin injections for axillary hyperhidrosis. Br. J. Surg., pp. 713–714. DOI: https://doi.org/10.1002/bjs.5347

  20. 20.

    Schnider AE, Moraru E, Kittler H et al (2001) Treatment of focal hyperhidrosis with botulinum toxin type A : long-term follow-up in 61 patients. Br J Dermatol 145:289–293. https://doi.org/10.1046/j.1365-2133.2001.04349.x

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Licht PB, Pilegaard HK (2004) Severity of compensatatory sweating after thoracoscopic sympathectomy. Ann Thorac Surg (78):437–431. https://doi.org/10.1016/j.athoracsur.2004.02.087

Download references

Author information

Affiliations

Authors

Contributions

Lynch OE: Data collection, manuscript writing

Aherne T: Manuscript writing/editing

Gibbons J: Data collection, editing

Boland MR: Data analysis, editing

Ryan ÉJ: Data analysis, editing

Boyle E: Editing, concept

Egan B: Editing, concept

Tierney S: Protocol/project development, manuscript writing/editing

Corresponding author

Correspondence to Olwyn E. Lynch.

Ethics declarations

Ethical approval was sought and obtained from the local Research Ethics Committee.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lynch, O.E., Aherne, T., Gibbons, J. et al. Five-year follow-up of patients treated with intra-dermal botulinum toxin for axillary hyperhidrosis. Ir J Med Sci 189, 1023–1026 (2020). https://doi.org/10.1007/s11845-019-02131-3

Download citation

Keywords

  • Axillary hyperhidrosis
  • Botulinum
  • Follow-up