Primary Axillary Hyperhidrosis Research Articles

Tumescent Suction Curettage versus Minimal Skin Resection with Subcutaneous Curettage of Sweat Glands in Axillary Hyperhidrosis

Axillary hyperhidrosis is a common problem with a strong negative impact on professional and social life. Various types of surgical procedures have been developed for its treatment. We want to compare efficacy and risk-benefit ratio of two local surgical procedures, i.e., the minimal skin excision with subcutaneous curettage (Method A) and tumescent liposuction curettage (Method B). A total of 163 patients with primary axillary hyperhidrosis as assessed by positive iodine-starch test were included. The age range of patients was 16 to 61 years (mean 28 years), including 33 males and 129 females. A total of 125 underwent Method A, and 37 were treated by Method B. Both procedures were performed in tumescent anesthesia. The mean follow-up was 21 months (Method A) and 48 months (Method B). The outcome was evaluated by patient's global assessment and by Minor's starch test. Patient satisfaction was scored as "satisfied,""partially satisfied," or "dissatisfied." Adverse effects, complications, hospitalization time, and time to return to work were recorded and compared for both methods. In patients who underwent Method A, scar formation was assessed only for the first axilla (n=99). In Method A, the rate of residual sweating was 12.0%. The relapse rate was 1.0% of patients or 2% of axillae. In Method B, the relapse rate was 16.2% of patients or 14.5% of axillae within 12 months. If we consider both the relapses and the residual sweating, this modified relapse rate per axilla was 12.8% for Method A and 14.5% for Method B. Patients who underwent Method B had significantly less pain, no atrophic or hypertrophic scars, and no complications such as wound infections, bleeding (with the need of a second operation), or delayed healing. Using Method A, the stay in hospital was on average 5.8 days per patient or 3.2 days per axilla. Mean time to return to work was 8.8+/-3.5 days. For Method B, the procedure was performed in an outpatient setting. The mean time to return to professional work was 1.3+/-0.8 days. The total satisfaction rate was 97% for Method A and 89.2% for Method B, respectively. As shown by this study, minor skin resection with subcutaneous curettage of axillary sweat glands (Method A) is somewhat more effective in permanent reduction of hyperhidrosis than suction curettage. The minimal invasiveness of suction curettage and the minimal scarring, however, are significant advantages over excisional surgery. Downtime after surgery is significantly shorter for suction curettage. Therefore, suction curettage might be the surgical treatment of choice for axillary hyperhidrosis.

Efficacy of Botulinum Toxin Type A in the Treatment of Focal Axillary Hyperhidrosis

Local intradermal injection of botulinum toxin Type A has become a recognized treatment for axillary hyperhidrosis. This study has investigated the efficacy of this method of treatment in terms of symptom-free interval between treatments and patients' satisfaction. We also investigated the reliance on patients' subjective assessment of the recurrence of symptoms in determining the timing of repeat injections. All patients referred to our clinic between May 2001 and December 2005 with a diagnosis of focal primary axillary hyperhidrosis were included in this study. Data were collected prospectively in a standard proforma. Every patient received a questionnaire to complete over a 4-week period. The questionnaire included visual analogue scales for periprocedural pain, degree of dryness, satisfaction, regret, and complications. Final symptom-free interval was recorded when the patient requested a repeat injection. The data were recorded on a spreadsheet and analyzed using standard statistical methods. A total of 52 consecutive patients and 238 axillary injections were analyzed. The symptom-free interval ranged from 3 to 14 months with a median of 5.97 months. There were no significant complications from this treatment modality. A total of 97% of the patients were highly satisfied with only 1 patient regretting the treatment. Botulinum toxin Type A is an effective and well-tolerated treatment for axillary hyperhidrosis. Timing of repeat injections as determined subjectively by patients is comparable to studies using colorimetric and gravimetric techniques to quantify the severity of sweating prior to the administration of repeat injections. The authors have indicated no significant interest with commercial supporters.

Injectable Botulinum Toxin as a Treatment for Plantar Hyperhidrosis

Hyperhidrosis is defined as excessive and uncontrollable sweating due to overactivity of the eccrine sweat glands. The first line of treatment for plantar hyperhidrosis consists of conservative therapies such as topical solutions (ie, antiperspirant applications and aluminum chloride preparations) and iontophoresis. When the patient has failed these standard treatments, the other available medical options are rather limited and not well tolerated. Botulinum toxin type A (Botox, Allergan Inc, Irvine, California) is a purified neurotoxin complex approved by the US Food and Drug Administration in 2004 for multiple medical conditions, including severe primary axillary hyperhidrosis that failed conservative topical therapies. Few recent clinical studies have suggested that botulinum toxin is effective in the treatment of plantar hyperhidrosis. In this case study, two patients received intradermal injections of botulinum toxin type A into the plantar aspect of both feet. A 3-month follow-up evaluated the efficacy of botulinum toxin type A by subjectively assessing the amount of residual sweating. In these two patients, botulinum toxin type A was an effective and safe treatment for plantar hyperhidrosis.

Botulinum toxin type A in the treatment of primary axillary hyperhidrosis: A 52-week multicenter double-blind, randomized, placebocontrolled study of efficacy and safety

Botulinum toxin type A in the treatment of primary axillary hyperhidrosis: A 52-week multicenter double-blind, randomized, placebocontrolled study of efficacy and safety

Assessment of quality of life in patients with primary axillary hyperhidrosis before and after suction-curettage

Focal axillary hyperhidrosis (FAH) is a benign functional disorder that may lead to social and psychologic handicap. Hence, the improvement of quality of life is a major aim of therapy. Several studies evaluating the quality of life before and after application of topical agents, injections with botulinum toxin, and thoracoscopic sympathectomy have been reported. However, changes of quality of life after minimally invasive surgical procedures such as suction-curettage (SC) have not been investigated so far. We sought to evaluate the quality of life in patients with FAH before and after SC using the validated Dermatology Life Quality Index (DLQI). In all, 51 patients who underwent SC were followed up for 9 months. The DLQI was completed by the patients before and 9 months after surgery. In addition, scores for patient satisfaction and improvement of FAH were applied. The median DLQI score before treatment was 12 (range: 9-18). Nine months after surgery a significant decrease of the DLQI score was observed (median: 4; range: 2-8) resulting in a relative reduction and improvement of the DLQI score of 63.4% (range: 33-83; P < .05), respectively. A significant sweat reduction was reported in 68.6% of patients experiencing a decrease of sweating of at least 75% after SC. Moreover, 78.4% of the patients were very or completely satisfied with the surgical procedure. Only severe cases of hyperhidrosis, refractory to conservative therapy, were included. No objective outcome measure (eg, gravimetry) was included. Our data support results of previous studies demonstrating that FAH is associated with considerably reduced quality of life. SC is an effective surgical therapy option that can largely reverse the disabilities experienced by patients with excessive axillary sweating.

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

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. To assess 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. The effect of total surface area involvement on treatment efficacy was not evaluated. BoNTA treatment effectively reduces the symptoms of primary axillary hyperhidrosis and is well tolerated.

Treatment of axillary hyperhidrosis with botulinum toxin type A reconstituted in lidocaine or in normal saline: a randomized, side-by-side, double-blind study

Botulinum toxin type A represents a safe and effective treatment for primary axillary hyperhidrosis. One of the most troublesome disadvantages associated with this therapy is pain at the injection sites. Reconstitution of botulinum toxin A in a solution of lidocaine could be an easy alternative procedure to reduce the discomfort associated with those injections. However, the current recommendations are that botulinum toxin A should be reconstituted in normal saline. To compare the efficacy and tolerance profile of saline-diluted botulinum toxin A and lidocaine-diluted botulinum toxin A in patients with axillary hyperhidrosis. In a double-blind, side-by-side, controlled, randomized clinical trial, 29 patients were injected with 100 mouse units of botulinum toxin A (Botox); Allergan Pharmaceuticals Ireland, Westport, Ireland) reconstituted in lidocaine into one axilla and with the same dosage of the toxin, reconstituted in an equal volume of saline, into the other axilla. The patients were followed up for 8 months. Quantification of sweat production was performed by iodine-starch tests and by the patients' own rating of sweating. The intensity of pain associated with the botulinum toxin intracutaneous injections was self-assessed by the patients and was evaluated using a 100-mm visual analogue scale. Botulinum toxin A diluted in normal saline and botulinum toxin A diluted in lidocaine were similarly effective in terms of control of onset of sweat production, duration of effect and subjective percentage of mean decrease in sweating. Both treatments were well tolerated, and there were no lasting or severe adverse effects. However, the mean +/- SD pain score during the procedure was significantly lower in the axillae treated with lidocaine-reconstituted botulinum toxin than in the axillae treated with saline-reconstituted botulinum toxin (29.3 +/- 20.1 vs. 47.5 +/- 24.0; P = 0.0027). Short- and long-term results show the equal effectiveness of botulinum toxin A reconstituted in saline or in lidocaine. However, because injections of botulinum toxin A reconstituted in lidocaine are associated with significantly reduced pain, lidocaine-reconstituted botulinum toxin A may be preferable for treating axillary hyperhidrosis.

Four-year longitudinal data on the efficacy and safety of repeated botulinum toxin type A therapy for primary axillary hyperhidrosis

Four-year longitudinal data on the efficacy and safety of repeated botulinum toxin type A therapy for primary axillary hyperhidrosis

Functional and dermatology-specific quality of life benefits with repeated botulinum toxin type A treatment of primary axillary hyperhidrosis over 4 years

Functional and dermatology-specific quality of life benefits with repeated botulinum toxin type A treatment of primary axillary hyperhidrosis over 4 years

A Double‐Blind, Randomized, Comparative Study of Two Type A Botulinum Toxins in the Treatment of Primary Axillary Hyperhidrosis

Botulinum toxin (BTX) is an effective treatment for primary axillary hyperhidrosis. In this study we used two toxins not bioequivalent: BOTOX (Allergan, Inc.) and Dysport (Beaufour Ipsen Biotech). The objective was to compare the efficacy, safety, and tolerability of BOTOX and Dysport in the treatment of primary axillary hyperhidrosis using a conversion factor of 1:3, respectively. In a double-blind, randomized prospective study, 10 patients with primary axillary hyperhidrosis and sweat production exceeding 50 mg/minute received 50 U of BOTOX in one axilla and 150 U of Dysport in the other. We performed Minor's test and gravimetry at 0 days, at 15 days, and monthly for 1 year. No significant difference was observed in the sweating quantity at baseline. After 1 month all patients had achieved success for both axillae. The sweat rate was reduced by a mean of 97.7% for BOTOX and 99.4% for Dysport, without statistical difference. The duration of benefits was similar between both toxins, with a mean of 260 days for BOTOX and 290 days for Dysport, without statistical difference. The longest symptom-free interval was 12 months (5 patients, 55.6%). BOTOX and Dysport presented similar levels of safety and efficacy in the treatment of primary axillary hyperhidrosis when a conversion factor of 1:3 was used.

Topically Applied Botulinum Toxin Type A for the Treatment of Primary Axillary Hyperhidrosis

The objective was to demonstrate that botulinum toxin type A (BTX-A) can be delivered to targeted skin sites with topical application for the treatment of primary axillary hyperhidrosis. This randomized, blinded, vehicle-controlled study enrolled 12 patients with primary axillary hyperhidrosis with greater than 50 mg of sweat produced per 5 minutes. BTX-A (200 U), combined with a proprietary transport peptide molecule to bind the toxin in a noncovalent manner, was topically applied to one axilla; vehicle without BTX-A was applied to the other axilla. Rates of sweat production were measured and imaged at baseline and 4 weeks after application. Two patients were excluded from analyses. At 4 weeks, 10 axillae treated topically with BTX-A demonstrated a 65.3+/-21.5% mean reduction in sweating relative to the same-patient, vehicle-control axillae, which had a 25.3+/-66.2% mean reduction. The 40% difference in mean sweat reduction between groups was statistically significant (p<.05). Quantitative image analysis of the results of the Minor's iodine starch test confirmed the reduction of sweat production in the BTX-A-treated versus the vehicle-treated axillae. Topically applied BTX-A appears to be safe and may prove to be effective for the treatment of axillary hyperhidrosis.

Topical atropine sulfate for the treatment of axillary hyperhidrosis

Axillary hyperhidrosis does not have a low-cost, free of secondary effects, satisfactory treatment. Eccrine hidrocystomas have been successfully treated with topical atropine solution. Hypothesis Axillary hyperhidrosis could respond to the topical application of atropine solution. Ten patients were selected. Eight with mild pure primary axillary hyperhidrosis and two with compensatory sweating after sympathectomy. One milliliter of a water solution of atropine sulfate at 1% was applied twice a day over the affected area and massaged for 30 s. Treatment was maintained for 15 days. The results were rated using a scale from 1 to 10 of satisfaction. Only 2 of the 10 treated patients responded partially to the topical application of atropine sulfate. No local or systemic secondary effects were observed. The results of the study demonstrated that focal hyperhidrosis does not improve after the local application of anticholinergic drugs such as atropine sulfate.

Prospective Open-Label Study of Botulinum Toxin Type A in Patients with Axillary Hyperhidrosis: Effects on Functional Impairment and Quality of Life

Patients with primary axillary hyperhidrosis experience substantial functional impairment and reduced health-related quality of life (HRQOL). Few studies have comprehensively evaluated the effects of botulinum toxin type A (BoNT-A) on these symptoms. To prospectively assess the effects of BoNT-A on functional impairment associated with primary axillary hyperhidrosis. Patients treated with BoNT-A 50 U per axilla at baseline were assessed 4 and 12 weeks later. Outcome measures included functional impairment as assessed by the Hyperhidrosis Disease Severity Scale and the Hyperhidrosis Impact Questionnaire and dermatology-specific HRQOL as assessed by the Dermatology Life Quality Index. At weeks 4 and 12 after BoNT-A treatment, 85% and 90% of patients achieved the a priori definition of treatment responder. Patients reported less occupational and emotional impairment, spent less time managing their hyperhidrosis, and had fewer difficulties in social situations. Adverse events were uncommon (5.5%), were mild, and did not require treatment. At study end, 53% of patients reported no dermatology-specific HRQOL impairment and 90% were satisfied with treatment. Significant, meaningful, rapid, and durable reductions in disease severity and functional impairment, as well as improvements in HRQOL, were seen following BoNT-A treatment. BoNT-A was safe and well tolerated, producing high levels of patient satisfaction.

Prospective evaluation of the efficacy of dermal botulinium toxin for primary axillary hyperhidrosis

Primary axillary hyperhidrosis (PAH) is an embarassing, socially disabling condition, most commonly seen in young people. Previous treatments for this condition have included sympathectomy or axillary skin excision. Recently botulinum toxin has been used to provide effective, non-invasive treatment for this condition. To investigate the effect of botulinum toxin injection in patients with PAH on sweat production and psychological wellbeing. Ten patients were assessed before treatment with botulinum toxin injection using gravimetric analysis and a psychometric questionnaire. Patients were reassessed at intervals of one, four and twelve weeks following treatment. Injection with botulinum toxin resulted in significant improvement in patients physical symptoms and psychological wellbeing. However, improvement was short-lived with recurrence of symptoms at three months. Botulinum toxin injection provides very effective short-term relief of PAH. While its limitations should be recognised and explained when consenting patients for treatment, this does not necessarily diminish its value in the treatment of PAH.

Low rate of neutralising antibody formation to botulinum toxin type A in the course of treatment of primary axillary hyperhidrosis

Low rate of neutralising antibody formation to botulinum toxin type A in the course of treatment of primary axillary hyperhidrosis

Low-Dose Efficacy of Botulinum Toxin A for Axillary Hyperhidrosis

To compare 2 doses of botulinum toxin A in view of dose-dependent efficacy, longevity, and safety. Side-by-side, controlled, randomized clinical trial with extended follow-up over 2 treatment cycles. Patients were injected with 200 U of botulinum toxin A (Dysport; Ipsen Ltd, Wrexham, England) into one axilla and 100 U into the other axilla in a randomized fashion. After 48 weeks of follow-up, the patients were given a second treatment with identical doses to the respective axillae and were again followed up for 48 weeks. Gravimetric measurements of sweat production and the patients' own rating of sweating were monitored. University-based outpatient clinic. Forty-three subjects with primary axillary hyperhidrosis that was unresponsive to topical therapy. Absolute values of sweat production. Two weeks after treatment, the sweat production was significantly reduced compared with baseline levels. Both doses were equally effective. At week 48, the sweat production had returned to baseline levels irrespective of the dose. After the second treatment, both doses were again equally effective at any follow-up point. At the end of the follow-up period (96 weeks) for the second treatment, the sweat production was significantly lower than at the end of the first follow-up period (48 weeks). The treatment was well tolerated, and there were no lasting or severe adverse effects. Short- and long-term results show that doses of 100 and 200 U of botulinum toxin A are equally safe and effective. However, because of cost considerations and possible adverse effects, the lower dose is preferable for treating axillary hyperhidrosis.

Thoracoscopic Sympathectomy for Axillary Hyperhidrosis: The Influence of T4

Recent data suggest that severe compensatory sweating after sympathectomy for hyperhidrosis is more common than previously reported. In particular, T2-T4 sympathectomy for axillary hyperhidrosis leads to significantly more disabling sweating compared with T2-T3 sympathectomy for palmar hyperhidrosis. However, it is not known whether this is a result of the additional transection of the T4 segment or if patients with primary axillary hyperhidrosis are more prone to experience disabling compensatory sweating. A follow-up study by questionnaire was made of 100 consecutive patients who underwent thoracoscopic sympathectomy for axillary hyperhidrosis at two university hospitals. Patients underwent T2-T3 sympathectomy (n = 35) or T2-T4 sympathectomy (n = 65) depending on the surgeon's preference. The questionnaire was returned by 91% of patients after a median of 31 months. Compensatory sweating occurred in 90% of patients and was so severe in 61% that they often had to change clothes during the day. There were no significant differences in occurrence or severity of compensatory sweating between the two extents of sympathectomy. Surgical outcome, however, was significantly better after T2-T4 sympathectomy. In contrast with previous reports, the incidence of compensatory sweating was not significantly related to the extent of sympathectomy for axillary hyperhidrosis. This result suggests that patients with primary axillary hyperhidrosis are more prone to experience compensatory sweating. Although the majority of patients with axillary hyperhidrosis were satisfied after thoracoscopic sympathectomy, many regret the operation. Patients should undergo surgery only if medical treatments fail; and provided there is an indication, we recommend T2-T4 sympathectomy.

Pilot study of the safety and efficacy of Myobloc™ (botulinum toxin type B) for treatment of axillary hyperhidrosis

Botulinum toxin type B (BTX-B, Myobloc, San Francisco, CA, USA) was FDA-approved for the treatment of cervical dystonia in December 2000. It has since been used off-label for the treatment of axillary hyperhidrosis. However, there are sparse data in the medical literature evaluating the safety and efficacy of Myobloc (botulinum toxin type B) for this indication. To assess the safety, efficacy and duration of action of Myobloc (botulinum toxin type B) in the treatment of bilateral axillary hyperhidrosis. This study was a double-blinded, randomized, pilot study conducted in an outpatient office setting at a private academic medical center beginning in November 2001. Twenty-three male and female volunteers between the ages of 18 and 80 were screened for participation; 20 participants with primary axillary hyperhidrosis were enrolled. Participants were injected subcutaneously with either Myobloc (botulinum toxin type B) (2500 U, or 0.5 ml, per axilla) or 0.5 ml vehicle (100 mM NaCl, 10 mM succinate, and 0.5 mg/ml human albumin) into bilateral axillae. Participants who received placebo were rolled over and received Myobloc (botulinum toxin type B) at subsequent visits. All participants were followed until sweating returned to baseline levels. This trial was initially conceived as a placebo-controlled study; however, owing to the insufficient size of the placebo group, the placebo arm of this trial was dropped during data analysis. The main outcome measures were safety, efficacy, and duration of effect. According to participant assessment of axillary hyperhidrosis improvement (A-HI) and quality of life (A-HQOL) scores and the physician assessment scores, a significant difference was observed in treatment response at Day 30 in the participants receiving Myobloc (botulinum toxin type B) injections. Duration of action ranged from 2.2 to 8.1 months (mean 5.0 months). The adverse event profile included bruising, flu-like symptoms, and dry eyes. Myobloc (botulinum toxin type B) proved to be safe and efficacious for the treatment of bilateral axillary hyperhidrosis. More studies are needed to assess the duration of response using different doses of Myobloc (botulinum toxin type B).

Prospective Open-Label Study of Botulinum Toxin Type A in Patients with Axillary Hyperhidrosis

Patients with primary axillary hyperhidrosis experience substantial functional impairment and reduced health-related quality of life (HRQOL). Few studies have comprehensively evaluated the effects of botulinum toxin type A (BoNT-A) on these symptoms. Objective To prospectively assess the effects of BoNT-A on functional impairment associated with primary axillary hyperhidrosis. Methods Patients treated with BoNT-A 50 U per axilla at baseline were assessed 4 and 12 weeks later. Outcome measures included functional impairment as assessed by the Hyperhidrosis Disease Severity Scale and the Hyperhidrosis Impact Questionnaire and dermatology-specific HRQOL as assessed by the Dermatology Life Quality Index. Results At weeks 4 and 12 after BoNT-A treatment, 85% and 90% of patients achieved the a priori definition of treatment responder. Patients reported less occupational and emotional impairment, spent less time managing their hyperhidrosis, and had fewer difficulties in social situations. Adverse events were uncommon (5.5%), were mild, and did not require treatment. At study end, 53% of patients reported no dermatology-specific HRQOL impairment and 90% were satisfied with treatment. Conclusions Significant, meaningful, rapid, and durable reductions in disease severity and functional impairment, as well as improvements in HRQOL, were seen following BoNT-A treatment. BoNT-A was safe and well tolerated, producing high levels of patient satisfaction.

Effectiveness and patient satisfaction with topical aluminum chloride and endoscopic transthoracic sympathectomy for primary axillary hyperhidrosis: A literature review

Effectiveness and patient satisfaction with topical aluminum chloride and endoscopic transthoracic sympathectomy for primary axillary hyperhidrosis: A literature review