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)

Summary

Botulinum toxin type A injections are an effective and well-tolerated treatment for hyperhidrosis. This paper outlines the current treatment options for hyperhidrosis and proposes a positioning for botulinum toxin type A based on the clinical evidence from published trials. Botulinum toxin type A is a valuable therapy for the treatment of hyperhidrosis, and future research will continue to expand the indications for which it is licensed.

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Reprint Address

Dr N.J.Lowe MD, Cranley Clinic, 3 Harcourt House, 19a Cavendish Square, London W1G 0 PN, U.K. E-mail: cranleyuk@aol.com

Cite this: The Place of Botulinum Toxin Type A in the Treatment of Focal Hyperhidrosis - Medscape - Dec 01, 2004.

Table 1. Examples of Causes of Hyperhidrosis (From Stolman ⁷)
Generalized (essential or primary)
Environment	Heat, humidity, exercise
Febrile disease	Acute and chronic infections, neoplasia
Metabolic	Thyrotoxicosis, diabetes mellitus, hypoglycaemia, gout, pheochromocytoma, hyperpituitarism, menopause
Sympathetic discharge	Shock and syncope, intense pain, alcohol, drug withdrawal
Neurological	RileyDay syndrome, irritative hypothalamic lesions
Drugs	Propranolol, physostigmine, pilocarpine, tricyclic antidepressants, venlafaxine
Localized
Extrinsic	Heat, olfactory
Gustatory	Citric acid, coffee, chocolate, peanut butter, spicy food
Neurological	Lesions, primary or essential hyperhidrosis

Table 2. Levels of Evidence (From US Agency for Health Care Policy and Research ⁴⁸)
Ia	Evidence obtained from meta-analysis of randomized controlled trials
Ib	Evidence obtained from at least one randomized controlled trial
IIa	Evidence obtained from at least one well-designed controlled study without randomization
IIb	Evidence obtained from at least one other type of well-designed quasi-experimental study
III	Evidence obtained from well-designed non-experimental descriptive studies such as comparative studies, correlation studies and casecontrol studies
IV	Evidence obtained from expert committee reports or opinions and/or clinical evidence of respected authorities