Efficacy and Safety of Botulinum Toxin A in Axillary Bromhidrosis and Associated Histological Changes in Sweat Glands: A Prospective Randomized Double-Blind Side-by-Side Comparison Clinical Study

Abstract

BACKGROUND The efficacy of botulinum toxin A (BTX-A) therapy in axillary hyperhidrosis has been documented; however, there are a few studies reporting the efficacy of BTX-A in treating axillary bromhidrosis. The histological changes occurring in sweat glands after BTX-A treatment are also unknown. OBJECTIVE The authors report on the efficacy and safety of BTX-A in the treatment of axillary bromhidrosis and on the histological changes in sweat glands after BTX-A treatment. MATERIALS AND METHODS Nineteen patients were included in this study. The patients were administered BTX-A injection in one axilla and sterile normal saline as placebo in the other axilla. The degree of malodor was evaluated subjectively by the patients before and 3 months after treatment. Sweat secretion was quantified by the gravimetric method. All patients underwent standard apocrinectomy in both axillary regions. RESULTS The mean degree of malodor and mean sweat production in the BTX-A–treated axilla were significantly lower than those in the control axilla (2.42 vs 8.00; p < .0001 and 13.33 vs 33.75 mg/min; p = .0028, respectively) at 3 months after therapy. The histological studies showed apocrine sweat glands with atrophic changes and hypoplasia in treated axilla. CONCLUSION BTX-A injection is an easy, fast, noninvasive method of treating axillary bromhidrosis.

Effect of optimizing the use of endoscope on the efficiency of microdynamic bromhidrosis removal operation

“…Injection of botulinum toxin type A 8 inhibits sweat gland secretion by blocking the release of acetylcholine, but it lasts no more than 12 months. 9 Surgical removal of sweat glands is the only way to cure bromhidrosis. The scope of surgical operation mainly depends on range and depth of apocrine sweat glands distribution.…”

Botulinum Toxin Type B for Hidradenitis Suppurativa: A Randomised, Double-Blind, Placebo-Controlled Pilot Study

“…The apocrine gland responds to adrenergic substances, but whether or not cholinergic substances have an effect on apocrine sweat secretion is more obscure [ 26 , 27 ]. BTX-A, which inhibits cholinergic innervation, has an effect on bromhidrosis, and histological studies show apocrine sweat glands with atrophic changes and hypoplasia in skin treated with BTX-A [ 28 – 30 ]. One might speculate as to whether BTX-B has an effect on HS through decreasing the production of apocrine sweat.…”

Therapeutic Use of Botulinum Neurotoxins in Dermatology: Systematic Review

“…Wu et al recently published the results of a prospective randomized clinical study in association with histological analysis of sweat glands in axillary bromhidrosis treated with BoNT-A [54]. The mean degree of malodor and mean amount of sweat in the BoNT-Atreated axilla was substantially lower at 3 months after treatment than in the control axilla.…”