Botulinum toxin type A in primary palmar hyperhidrosis: randomized, single-blind, two-dose study.
BACKGROUND
Primary palmar hyperhidrosis is characterized by excessive sweating due to increased sympathetic cholinergic sudomotor nerve traffic to the palmar surface of the hands. Clinical studies suggest that intradermal injections of botulinum toxin are effective in the treatment of palmar hyperhidrosis.


OBJECTIVE
To establish the effectiveness of intradermal botulinum toxin in reducing hyperhidrosis, to determine the most effective dose of toxin, and to examine its effect on muscle strength.


METHODS
In a prospective, single blind, randomized trial, 24 patients with severe palmar hyperhidrosis received either a low (50 U) or a high dose (100 U) of botulinum toxin type A (Botox, Allergan) injected intradermally in 20 sites in each palm.


RESULTS
Following injection with either dose, iodine starch test revealed a significant decrease in sweating within the first month. Six months after injection, the anhidrotic effect was still evident in two thirds of the patients in both groups. Handgrip strength was not affected with either dose but finger pinch strength, 2 weeks after the injection, decreased 23 +/- 27% with 50 U (p < 0.05) and 40 +/- 21% with 100 U (p < 0.001). Pinch strength improved gradually but 6 months after treatment it was still 7-11% lower than at baseline.


CONCLUSIONS
Both 50 and 100 U of botulinum toxin type A, injected intradermally in each hand, decreased sweating in patients with primary hyperhidrosis for at least 2 months in all the patients, and 6 months in most patients. Weakness in the intrinsic muscles of the hand was observed.
Saadia
D
D
Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA.
Voustianiouk
A
A
Wang
A K
AK
Kaufmann
H
H
D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006225:Hand / Q000294:innervation; D006801:Humans; D006945:Hyperhidrosis / Q000188:drug therapy* / Q000503:physiopathology; D007271:Injections, Intradermal; D008297:Male; D011446:Prospective Studies; D016037:Single-Blind Method; D013564:Sympathetic Nervous System / Q000187:drug effects / Q000503:physiopathology
D019274:Botulinum Toxins, Type A