Botulinum toxin-a possible new treatment for axillary hyperhidrosis

Abstract

The inhibitory action of botulinum toxin is not limited to the neuromuscular junction. The toxin also blocks the autonomic cholinergic fibres, including the sympathetic fibres to sweat glands. We have previously demonstrated that the toxin produces localized anhidrosis. To determine the dosage, pattern and duration of the anhidrotic effect of botulinum toxin and to test the efficacy of axillary injections, we further studied seven healthy volunteers. Two individuals had subcutaneous injections of botulinum toxin (20 mouse units, Dysport-Porton Products) in the dorsum of the hand. Five healthy volunteers had 15-50U of botulinum toxin A (Botox) injected in one axilla. A circular area of complete anhidrosis on the dorsum of the hand was evident on day 2 and persisted for 11 months. By day 3, two of the axillae (injected with 50 U each) were totally dry and in one (injected with 30 U) the sweating was substantially reduced. The effect persisted for 6-8 months before wearing off. No effect was appreciated in two axillae (injected with 15 and 20 U). No significant side-effects were encountered. Subcutaneous injections of botulinum toxin causes chemodenervation of the sweat glands. In normal individuals axillary sweating can be abolished by 50 U of botulinum toxin A (Botox). The results offer a possible novel treatment for severe cases of axillary hyperhidrosis.

Focal Hyperhidrosis

“…3 Earlier studies have shown its effect in reducing sweat production in normal volunteers. 4,5 After our successful botulinum toxin treatment of excessive palmar hyperhidrosis in a single patient, 6 we studied the therapeutic effects of botulinum toxin in patients with various types of focal sweating. success was documented by the Minor test and quantitatively by measurement of spontaneous sweat secretion.…”

“…Except for a few self-experiments in volunteers 4,5 and a recent case report from this group, 6 to our knowledge there are no reports in the literature on the efficacy of botulinum toxin injections on various excessive focal sweating disorders, such as axillary, palmar, or plantar hyperhidrosis.…”

Frey syndrome treatment with botulinum toxin☆

“…36 Studies on human sweat glands partially support these data. 39 Small volumes of concentrated botulinum toxin have the advantage of minimizing the diffusion and possible side effects. However, if side effects do occur, they would be more disabling because of the higher concentration.…”

Diagnosis and Treatment of Primary Hyperhidrosis

“…It is a neurotoxin produced by anaerobic bacterium Clostridium botulinum (33). This form of treatment acts by inhibiting acetylocholine release in neuromuscular junction and, more importantly, in postganglionic sympathetic fibres that innervate the sweat glands what leads to the secretion of local anhydrase (34,35). The use of botulinum toxin type A seems to be an effective, safe and well-tolerated method of primary hyperhidrosis treatment.…”