Daily oscillations of sweating in hyperhidrotic individuals before and after treatment with botulinum toxin A

Abstract BACKGROUND: Primary focal hyperhidrosis is caused by excessive secretion by eccrine sweat glands, usually at axillae, palms and soles. The underlying mechanism is unclear. Botulinum toxin A is a highly efficient treatment for this condition. A subjective self-assessment scale has been shown to be a useful tool in assessing the variation in sweat levels before treatment. It has also been shown that treatment of hyperhidrosis with botulinum toxin A increases the patients’ quality of life. OBJECTIVES: To study the daily variations of sweating in hyperhidrotic individuals and how this affects quality of life (QOL) before and after treatment with botulinum toxin A, using a subjective self-assessment scale. METHODS: 18 patients with a history of hyperhidrosis (7 axillary, 5 palmar and 6 general) were studied. Each participant self-assessed rates of sweating for 7 days on an hourly basis using a subjective evaluation scale (SES) ranging from 0 to 10 before and one, three and six months after treatment with botulinum toxin A. The patients also recorded one VAS (Visual Analogue Scale) -QOL value before and after treatment. RESULTS: Following treatment, VAS-QOL increased in all patients (Median value before and after 5 and 9, respectively, p< 0,01), and there was also a reduction in sweating after one and three months in all patients (SES before = 4.2, SES 1 month = 0.8, SES 3 months = 0.9, p < 0.0001). After six months, the difference was not significant, but the values had not reached the pre-treatment level. Different patterns of sweating were observed before treatment, and most patients also showed the same pattern after treatment, but the values were lower. CONCLUSIONS: Successful treatment of hyperhidrosis with botulinum toxin A gives a significant increase in VAS-QOL and significantly decreases the sweat levels after one and three months