Botulinum Toxin A and Treatment of Hyperhidrosis

Botulinum toxin A injection therapy has been used successfully to reduce excessive sweating in all of the body areas affected in primary hyperhidrosis: axillary, palmoplantar, and facial/gustatory. Characterized as a “minimally invasive treatment option” compared to local surgery and endoscopic thoracic sympathectomy, the use of botulinum toxin A has become an important treatment option for patients not responding to more-conservative therapies.

OnabotulinumtoxinA (brand name Botox) has been approved for use in hyperhidrosis in Canada, the U.K. and other countries in Europe and South America (more than 25 countries total). In 2004, the US Food and Drug Administration (FDA) approved onabotulinumtoxinA for the treatment of severe primary axillary hyperhidrosis in patients unable to obtain relief using antiperspirants.

In a British Journal of Dermatology study (2000), researchers found botulinum toxin A to be an effective and safe treatment for frontal (cranio/facial) hyperhidrosis, with the amount of sweat being significantly reduced 4 weeks after treatment. The effect lasted at least 5 months in 9 of the 10 patients. All patients subjectively judged the treatment as very effective. Similarly, in another 2000 study (J Neurol.): "The effect of botulinum toxin A (BTX) was studied on 12 patients with idiopathic craniofacial hyperhidrosis... After 1-7 days, the craniofacial sweating in the area injected had completely ceased in 11 patients and was mildly reduced in the remaining one... Although sweating has not yet recurred in most patients at follow-up periods up to 27 months, one patient had a relapse 9 months after treatment. "

There are multiple forms of botulinum toxin-A on the market. Conversion ratios between the brandnames Botox (onabotulinum toxin-A), Dysport (abobotulinum toxin-A) and Xeomin (incobotulinum toxin-A) in clinical practice, according to an article in the journal toxins are: 

Botox and Xeomin - 1:1 (dose equivalent units)
Botox/Xeomin and Dysport - 1:2-3

According to the Cleveland Clinic, results may last longer and manifest faster with Xeomin and there may be fewer allergic reactions to Xeomin. Xeomin does not need to be refrigerated. Dysport may diffuse further or spread more. Effects of Dysport can last about the same as Botox but with Dysport effects visible at about 2 days compared to about 1 week with Botox. With all three injectables, FULL results will take a week or two to manifest. Of course results vary from individual to individual as well. Prices for the three injectables vary from practice to practice and should be discussed. 

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