title: The comparative effectiveness of suction-curettage and onabotulinumtoxin-A injections for the treatment of primary focal axillary hyperhidrosis: a randomized control trial.
abstract: BACKGROUND
  Botulinum toxin injections and suction-curettage have been separately shown to be effective in treating axillary hyperhidrosis but have not been compared in the same patients.
  
  
  OBJECTIVE
  We sought to compare effectiveness of suction-curettage versus neurotoxin for the treatment of axillary hyperhidrosis.
  
  
  METHODS
  Each of 20 patients was randomized to receive toxin injections to one axilla and suction-curettage to the contralateral axilla. The primary outcome measure was reduction of sweat rate measured by gravimetry, and the secondary measure was quality of life as measured by a patient-directed questionnaire.
  
  
  RESULTS
  At 3 months posttreatment, toxin injections decreased baseline resting sweat production by 72.1% versus 60.4% (P = .29) for suction-curettage, and baseline exercise-induced sweat production by 73.8% versus 58.8% (P = .10). When patients were stratified into the categories of light and heavy sweaters, there was a difference among heavy sweaters, with exercise-induced sweat production lower by 10.48 mg/min or 34.3% (P = .0025) at toxin-treated sites. Compared with suction-curettage, toxin also resulted in greater improvements in quality of life by 0.80 points (P = .0002) and 0.90 points (P = .0017) at 3 and 6 months posttreatment, respectively, as measured by the patient questionnaire.
  
  
  CONCLUSIONS
  The follow-up period was limited to 6 months.
  
  
  CONCLUSIONS
  By objective measures 3 months after treatment, neurotoxin injections are nominally more effective than suction-curettage in all cases, and markedly more effective in heavy sweaters. Patients have a very significant preference for neurotoxin injections at 3 months, and this is maintained at 6 months.
authors.affiliation: Department of Dermatology, Northwestern University, Chicago, Illinois 60611, USA.
authors.forename: Omer
authors.initials: O
authors.lastname: Ibrahim
authors.forename: Rohit
authors.initials: R
authors.lastname: Kakar
authors.forename: Diana
authors.initials: D
authors.lastname: Bolotin
authors.forename: Michael
authors.initials: M
authors.lastname: Nodzenski
authors.forename: Wareeporn
authors.initials: W
authors.lastname: Disphanurat
authors.forename: Natalie
authors.initials: N
authors.lastname: Pace
authors.forename: Lauren
authors.initials: L
authors.lastname: Becker
authors.forename: Dennis P
authors.initials: DP
authors.lastname: West
authors.forename: Emily
authors.initials: E
authors.lastname: Poon
authors.forename: Emir
authors.initials: E
authors.lastname: Veledar
authors.forename: Murad
authors.initials: M
authors.lastname: Alam
mesh_terms: D000328:Adult; D001365:Axilla; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D057186:Comparative Effectiveness Research; D005260:Female; D006801:Humans; D006945:Hyperhidrosis / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014619:Vacuum Curettage; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A