Botulinum Toxin Versus Placebo: A Meta-Analysis of Treatment and Quality-of-life Outcomes for Hyperhidrosis

Abstract

Aims This study aims at assessing the treatment effect, disease severity and quality-of-life outcomes of botulinum toxin (BTX) injections for focal hyperhidrosis. Methods We included randomized controlled trials of BTX injections compared with placebo for patients with primary or secondary focal hyperhidrosis. PubMed, Embase and the Cochrane Library were searched to August 2020. Gravimetric sweat rate reduction, disease severity measured by Hyperhidrosis Disease Severity Scale and quality-of-life assessment measured by Dermatology Life Quality Index were the outcomes of interest. Cochrane risk-of-bias tools were employed for quality assessment of given randomized controlled trials. Results Eight studies met our inclusion criteria (n=937). Overall, risk bias was mixed and mostly moderate. BTX injections showed reduced risk in comparison with placebo for the gravimetric quantitative sweat reduction of > 50 % from baseline (risk difference: 0.63, 95% CI 0.51 to 0.74). Additionally, improvements were seen for disease severity and quality-of-life assessments evaluated by Hyperhidrosis Disease Severity Score reduction of ≥ 2 points (risk difference: 0.56, 95% CI 0.42 to 0.69) and mean change in Dermatology Life Quality Index (mean difference: − 5.55, 95% CI − 7.11 to − 3.98). The acquired data were insufficient to assess for long-term outcomes and limited to an eight-week follow-up period. Conclusions In focal axillary hyperhidrosis, BTX significantly reduces sweat production and yields superior outcomes in assessments of disease severity and quality-of-life. However, the quality-of-evidence is overall moderate and included studies account for short-term trial periods only. Further studies assessing BTX in comparison with first-line treatments for hyperhidrosis are warranted. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Compensatory Hyperhidrosis After Non-Surgical Treatment of Primary Focal Hyperhidrosis: Two-Year Single-Centered Prospective Study From Jordan

“…16 In another trial about BTX-A, only one patient developed increased facial sweating after axillary hyperhidrosis. 17 On the other hand, a small observational prospective study found that there is no evidence of CH as measured by evapometry in patients diagnosed with palmar hyperhidrosis treated with botulinum toxin A, Although two of their 17 patients (11%) had reported subjective CH. 18 On the contrary, CH after surgical sympathectomy is thoroughly studied in the literature, but the pathogenesis and risk factors are still not well explained.…”

“…A clinical trial that aimed to investigate the safety and efficacy of BTX-A in axillary hyperhidrosis mentioned that only 11 patients (5%) developed CH. 16 In another trial about BTX-A, only one patient developed increased facial sweating after axillary hyperhidrosis. 17 On the other hand, a small observational prospective study found that there is no evidence of CH as measured by evapometry in patients diagnosed with palmar hyperhidrosis treated with botulinum toxin A, Although two of their 17 patients (11%) had reported subjective CH.…”

“…When we compared demographic and clinical variables of PH patients who developed CH with PH patients who did not, no significant difference was found in age (29, 28, p value = .32, Cohen's d = −0.09), weight (71, 70, p value = .86, Cohen's d = .04), BMI (23.9, 24.2, p value = .79, Cohen's d = .07). The axillary site was significantly different between CH +and CH-patients (16,25, p value = .05, Cramer's V = .21). No significant difference in gender, family history of PH, smoking status, or treatment type was observed between CH +and CH-patients as shown in Supplemental Table 3, it's of notice that CH only affected patients who had a partial or full response to treatment, and the frequency of CH among them was 24/76(31.5%).…”

Partos Cesáreas: Análise Pela Classificação De Robson X Experiências De Puérperas Do Sistema Único De Saúde (Sus) Assistidas No Hospital Santa Lucinda De Sorocaba-Sp

“…Os dados de notificação registrados no SINAN, no período entre 2011 e 2018, no estado do Espírito Santo, revelam que cerca de sete em cada dez casos de violência contra a pessoa com deficiência apresentavam caráter de repetição. Esse resultado é superior ao encontrado em grupos também vulneráveis como as crianças (P: 32,5%) (PEDROSO; LEITE, 2021) e pessoas idosas (P: 50,1%) (PAMPOLIM; LEITE (2021), demonstrando o quanto as pessoas com deficiência estão entre aqueles mais vulneráveis à permanência do ciclo da violência.…”

A comprehensive review on the history, uses, and safety of onabotulinum toxin type A (Botox)

“…These studies showed statistically significant improvement in overall DLQI mean score reduction from baseline to 2-8 week posttreatment, with a reported at least a 2-grade improvement in the HDSS. 97 Onabotulinum toxin A also has reported improvement in quality-of-life outcomes for nondermatologic conditions, such as poststroke lower limb spasticity, cervical dystonia, and masseter muscle hypertrophy. [98][99][100] 8 | SAFETY PROFILE…”