Double-blind trial of botulinum A toxin for the treatment of focal hyperhidrosis of the palms

Abstract

We performed a randomized double-blind study within-group comparison in 11 patients to study the effect of subcutaneous injections of botulinum A toxin in focal hyperhidrosis of the palms. A total dose of 120 mU (mouse units) of botulinum A toxin (Dysport) was injected into six different sites on one palm, whereas the other was injected with sterile saline. Objective quantification of sweat production was performed using digitized ninhydrin-stained sheets. Three weeks after treatment, the mean reduction of sweat production in the botulinum A toxin-treated palms was 26% (P < 0.001), after 8 weeks 26% (P = 0.002) and after 13 weeks 31% (P < 0.001). Subjective assessment of sweat production by the patients using a visual analogue scale showed a 38% improvement in the botulinum A toxin-treated palms at 3 weeks (P = 0.002), 40% at 8 weeks (P = 0.002) and 38% at 13 weeks (P = 0.002). Neither the objective measurement nor the subjective rating showed a statistically significant reduction of sweating in the placebo-treated palms. Three patients reported reversible minor weakness of powerful handgrip after injection at the toxin-treated site, lasting between 2 and 5 weeks.

Evidence-based medicine: botulinum toxin in focal hyperhidrosis

“…The required total doses were higher than in the treatment of axillary hyperhidrosis because of the larger area to be injected (palms and fingers) (range between 120 to 220 MU Botox  per palm or 120 MU Dysport  per palm). In a few studies quantifying sweat reduction after BTX-A [15,16,19,25,28], a significant decrease of sweating could be demonstrated after injection, well in accordance with the subjective estimation by the patients [25]. The duration of action varied between 4 and 12 months, but was mainly within a range of 4 to 6 months.…”

“…The positive effect of BTX-A on palmar hyperhidrosis has been demonstrated by some open studies [15,16,19,20,27,28] and by one small double-blind placebo-controlled trial [25]. The required total doses were higher than in the treatment of axillary hyperhidrosis because of the larger area to be injected (palms and fingers) (range between 120 to 220 MU Botox  per palm or 120 MU Dysport  per palm).…”

Botulinum toxin in multiple sclerosis

“…So far there are only a few controlled studies on the use of BoTx in palmar and plantar hyperhidrose [22,30]. Nice accomplishments have been described in gustatory sweating [9], albeit in open studies only [22].…”

Fokale Hyperhidrose

“…Intrakutan mit einer ca. 30 [50,51,56].Die Nebenwirkungen beschränkten sich auf vorübergehende Schwäche der Handmuskulatur, leichte Häma-tome an den Einstichstellen und Injektionsschmerz. Die Schwäche der Handmuskulatur äußerte sich vor allem als eine Verminderung des Pinzettengriffs.…”