title: Treatment of compensatory hyperhidrosis after sympathectomy with botulinum toxin and anticholinergics.
abstract: OBJECTIVE
  Compensatory hyperhidrosis (CH) is the most common adverse complication of sympathectomy. It often has a major negative impact on life quality. No efficient treatment of CH is available. We report nine cases of CH after sympathectomy, which were treated with botulinum toxin A/B (BTX) and anticholinergics.
  
  
  METHODS
  The patients responded to a dermatology life quality index (DLQI) questionnaire before injections with BTX and 3 weeks after treatment. At the follow-up visit, the participants also ranked the effect of the treatment on a five-grade scale. Three patients had residual sweating after BTX treatment, and received additional anticholinergics at the follow-up visit. Those subjects eventually had a third evaluation with the DLQI.
  
  
  RESULTS
  The DLQI score was, on average, 16.4 before treatment and decreased to 4.8 after BTX injections. Eight out of nine patients were satisfied with the treatment. The average DLQI score decreased to 2.2 when the patients with residual sweating (n = 3) received additional anticholinergics. Adverse events from BTX were mild and temporary, but dry mouth was substantial in one patient using anticholinergics.
  
  
  CONCLUSIONS
  A combination of BTX A/B and anticholinergics alleviated the hyperhidrosis with minor side-effects. We consider this treatment safe, effective, and well tolerated.
authors.affiliation: Department of Medical Sciences, Dermatology and Venereology, Uppsala University, Uppsala, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Karlsson-Groth
authors.forename: Alma
authors.initials: A
authors.lastname: Rystedt
authors.forename: Carl
authors.initials: C
authors.lastname: Swartling
mesh_terms: D000328:Adult; D000368:Aged; D001905:Botulinum Toxins / Q000009:adverse effects / Q000627:therapeutic use*; D018680:Cholinergic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006945:Hyperhidrosis / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D008333:Mandelic Acids / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D009407:Nerve Block; D010276:Parasympatholytics / Q000009:adverse effects / Q000627:therapeutic use; D017060:Patient Satisfaction; D011788:Quality of Life; D012879:Skin Physiological Phenomena / Q000187:drug effects; D011795:Surveys and Questionnaires; D013546:Sweating; D013563:Sympathectomy, Chemical / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D018680:Cholinergic Antagonists; D008333:Mandelic Acids; D010276:Parasympatholytics; D001905:Botulinum Toxins; C005419:oxybutynin