Botulinum toxin type B: a new therapy for axillary hyperhidrosis

doi:10.1016/j.bjps.2004.07.003

British Journal of Plastic Surgery

Volume 58, Issue 2, March 2005, Pages 228-232

https://doi.org/10.1016/j.bjps.2004.07.003 Get rights and content

Summary

Primary axillary hyperhidrosis is a disorder affecting mainly adolescents with significant adverse effects on quality of life. No ideal treatment exists, although recent data has demonstrated Botulinum toxin type A (Botox) as a treatment option. However, antibody formation may lead to loss of clinical benefit over time. Botulinum toxin type B (Neurobloc) has recently been introduced and may induce less immunogenic response.

Objective

To investigate the efficacy of Neurobloc for axillary hyperhidrosis.

Method

Thirteen patients (22 axillae) were recruited to the study. The hyperhidrotic area was defined using the iodine-starch test then measured and photographed. 5000 MU of Neurobloc was administered subdermally. Patients were reviewed at 4, 8 and 12 weeks to assess outcome objectively (hyperhidrotic area measurements and photographs) and subjectively (sweat production and patient satisfaction).

Results

There was a significant reduction in hyperhidrotic area at follow-up compared to baseline. Mean percentage reduction in hyperhidrotic area was 84, 87 and 81% at 4, 8 and 12 weeks (p=0.001, paired t test). Patient satisfaction was 100% throughout. Subjective mean percentage reduction in sweat production was 98, 96 and 90 at 4, 8 and 12 weeks. Side effects were minimal.

Conclusion

Neurobloc is an effective treatment for axillary hyperhidrosis.

Section snippets

Study design

Flow diagram of participant selection

Full ethical approval for the project was granted.

Procedure

The hyperhidrotic area for treatment was defined by Minor's iodine starch test under standardised conditions. The area of demarcation was marked, measured and photographed (Photo 1). The marked area was divided into equal sections. A total of 5000 units of botulinum toxin type B were injected subdermally into each axilla. The botulinum toxin was diluted with 0.9% saline and distributed into five 1 ml insulin

Participants

A total of 13 patients (22 axillae) were entered into the trial (Table 1). Three patients did not satisfy the study criteria.

Efficacy

All patients responded to treatment with a rapid onset of improvement of symptoms within one day. After injection of botulinum toxin type B, all patients had a significant reduction in hyperhidrotic area at 4, 8 and 12 weeks compared to baseline (Graph 1, p=0.0001).

The mean hyperhidrotic area at baseline was 88.1 cm² (Graph 2). There was a reduction in mean hyperhidrotic

Primary findings

Our results show significant reduction in hyperhidrotic area and improvement in reported patient symptoms compared to baseline following injection of 5000 MU of botulinum toxin type B intradermally into the axillae of patients with primary axillary hyperhidrosis. The onset of action was rapid and the effects were maintained for the duration of the trial follow-up. These results are comparable with other studies investigating the efficacy of botulinum toxin type A for axillary hyperhidrosis.9, 10

Acknowledgements

Vascular Unit, Aberdeen Royal Infirmary. Funding from Elan pharmaceuticals.

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Botulinum toxin: Pharmacology and injectable administration for the treatment of primary hyperhidrosis
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No consensus exists regarding the dosing of other BTX/A preparations.58 RimabotulinumtoxinB injections of 2500 to 5000 U per axilla also result in focal anhidrosis.96 Adverse effects observed in patients treated with onabotulinumtoxinA and abobotulinumtoxinA include pain, hematomas, bruises, headaches, muscle soreness, mild local pruritus, and urticaria, as well as compensatory sweating in 5% of patients.123-125
Hyperhidrosis is a dermatological condition defined by excessive sweating beyond thermoregulatory needs with significant effects on patients' quality of life. Hyperhidrosis is categorized as primary or secondary: primary hyperhidrosis is mostly focal and idiopathic, whereas secondary hyperhidrosis is commonly generalized and caused by an underlying medical condition or use of medications. Various surgical and nonsurgical therapies exist for primary hyperhidrosis. Although botulinum toxin is one of the deadliest toxins known, when used in small doses, it is one of the most effective therapies for primary hyperhidrosis. Botulinum toxin injections are widely used as a second-line primary hyperhidrosis treatment option once topical treatment strategies have failed. This article provides an overview of the commercially available botulinum toxin formulations and their applications in the treatment of primary hyperhidrosis.
The etiology, diagnosis, and management of hyperhidrosis: A comprehensive review: Therapeutic options
2019, Journal of the American Academy of Dermatology
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Contraindications to BTX include peripheral motor neuropathy or neuromuscular junction diseases (myasthenia gravis or Lambert–Eaton syndrome), pregnancy, lactation, allergy to any of the injectable components, and medications, such as aminoglycosides, penicillamines, cholinesterase inhibitors, quinine, and calcium channel antagonists.6,106,107,109,115-118 Regarding dosing, 1 mouse unit (MU) of onabotulinum is equivalent to 3 MUs of abobotulinum112 and 40 MUs of rimabotulinum.119-122 For each administration, the highest onabotulinum dose should not exceed 300 to 400 units.
Hyperhidrosis (HH) is a chronic disorder of excess sweat production that may have a significant adverse effect on quality of life. A variety of treatment modalities currently exist to manage HH. Initial treatment includes lifestyle and behavioral recommendations. Antiperspirants are regarded as the first-line therapy for primary focal HH and can provide significant benefit. Iontophoresis is the primary remedy for palmar and plantar HH. Botulinum toxin injections are administered at the dermal-subcutaneous junction and serve as a safe and effective treatment option for focal HH. Oral systemic agents are reserved for treatment-resistant cases or for generalized HH. Energy-delivering devices such as lasers, ultrasound technology, microwave thermolysis, and fractional microneedle radiofrequency may also be utilized to reduce focal sweating. Surgery may be considered when more conservative treatments have failed. Local surgical techniques, particularly for axillary HH, include excision, curettage, liposuction, or a combination of these techniques. Sympathectomy is the treatment of last resort when conservative treatments are unsuccessful or intolerable, and after accepting secondary compensatory HH as a potential complication. A review of treatment modalities for HH and a sequenced approach are presented.
Botulinum Toxin for Axillary Hyperhidrosis
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Hyperhidrosis Update
2010, Actas Dermo-Sifiliograficas
Nearly 3% of the population has hyperhidrosis. Quality of life is affected, impacting on social relationships and professional activity, and social anxiety disorder can sometime develop.
We review the definition and causes of hyperhidrosis and the clinical evaluation of patients. After describing the different clinical aspects of the condition, we discuss the medical and surgical treatments. Of such treatments currently available, particular mention is made of the use of botulinum toxin in some forms of hyperhidrosis as an intermediate option between the traditional treatments and surgery. We also draw attention to the use of minimal access surgical techniques (videothoracoscopy), which, over the past decade, have become established as an effective, safe, and permanent approach for the treatment of hyperhidrosis when indicated.
La hiperhidrosis afecta casi al 3% de la población. Hay una disminución de la calidad de vida que perjudica las relaciones sociales y las actividades profesionales, presentándose ocasionalmente fobia social.
En esta revisión se analiza el concepto y las causas de hiperhidrosis, así como la evaluación clínica del paciente que la padece. Tras discutir los distintos aspectos clínicos de la hiperhidrosis se revisan los diferentes tratamientos médicos y quirúrgicos.
Actualmente disponemos de varios tratamientos de tipo médico y quirúrgico. Se resalta la aportación de la toxina botulínica como opción intermedia en ciertas formas de hiperhidrosis, entre los tratamientos clásicos y el tratamiento quirúrgico. También se destaca la contribución de las técnicas quirúrgicas de acceso mínimo (videotoracoscopia), que se han consolidado en esta última década como una opción efectiva permanente y segura para el tratamiento de esta afección en los casos indicados.
Botulinum neurotoxin in the management of hyperhidrosis and other hypersecretory disorders
2009, Botulinum Toxin: Therapeutic Clinical Practice and Science, Expert Consult - Online and Print
Botulinum Neurotoxin in the Management of Hyperhidrosis and Other Hypersecretory Disorders
2009, Botulinum Toxin: Therapeutic Clinical Practice and Science

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: Presented at British Association of Plastic Surgeons Summer Meeting 2003.

View full text

Botulinum toxin type B: a new therapy for axillary hyperhidrosis

Summary

Objective

Method

Results

Conclusion

Section snippets

Study design

Procedure

Participants

Efficacy

Primary findings

Acknowledgements

Eur J Vasc Endovasc Surg

Hyperhydrosis: a review of current management

Plast Reconstr Surg

Surgical management of primary hyperhydrosis

Br J Surg

Long-term results of 630 thoracoscopic sympathicotomies for primary hyperhydrosis: the Vienna experience

Eur J Surg

Endoscopic thoracic sympathectomy for primary hyperhydrosis of the upper limbs. A critical analysis and long-term results of 480 operations

Ann Surg

Endoscopic thoracic sympathectomy

J Neurosurg

Needle thoracic sympathectomy for essential hyperhydrosis: intermediate-term follow up

Ann Thorac Surg