The Place of Botulinum Toxin Type A in the Treatment of Focal Hyperhidrosis

N. Lowe; A. Campanati; I. Bodokh; S. Cliff; P. Jaen; O. Kreyden; M. Naumann; A. Offidani; J. Vadoud; H. Hamm


The British Journal of Dermatology. 2004;151(6) 

In This Article

Impact of Disease

The line between 'normal' sweating and hyperhidrosis is poorly defined and objective evaluations of the disease are needed before treatment can be justified and evaluated. Subjective measurements can be used, as well as objective assessments such as gravimetric assessment of sweat production and Minor's iodine starch test; however, one of the main criteria for determining whether treatment is justified is the effect of the condition on the patient's QOL.[11]

It has always been known that dermatological conditions have a detrimental effect on patients' lives but it has only relatively recently been measured in a standardized, repeatable way. The effects of hyperhidrosis have been assessed on various QOL scales, such as the Dermatology Life Quality Index (DLQI) (a simple, practical method of scoring the impact of skin disease using 10 questions, each with four possible answers)[12] and the Hyperhidrosis Impact Questionnaire© (HHIQ).[6,13] The DLQI is a validated measure that allows comparison of hyperhidrosis with other dermatological conditions, whereas the HHIQ focuses specifically on how hyperhidrosis affects patients. Studies using both scales have shown that hyperhidrosis has a significant impact on patients' lives; however, there is still a low awareness of it as a true medical condition, and as such there is also a paucity of knowledge on the prevalence of the condition and a lack of information on the treatment options available. In some cases there is also a lack of clarity on the referral pathways for these patients and local reimbursement guidelines.