SYDNEY, AUSTRALIA (FRONTLINE MEDICAL NEWS) – Botulinum toxin therapy achieved substantial and durable improvements in symptoms in the majority of patients with axillary hyperhidrosis, in a retrospective study presented at the annual meeting of the Australasian College of Dermatologists.

Sydney dermatologist Robert Rosen, MMed, and his associates analyzed survey data from 200 patients with primary axillary hyperhidrosis who had been treated with 100 units of botulinum toxin at a hyperhidrosis referral center between 2006 and 2016. Patients were aged 12 years or older, and had had axillary hyperhidrosis for 6 months or longer that had not responded to treatment with 20% topical aluminum chloride.

Of these patients, 96% reported at least moderate satisfaction with the results of their treatment with botulinum toxin, with a mean satisfaction rating of 3.41 on a four-point scale that ranged from 1 (slight improvement) to 4 (complete abolition of signs and symptoms).

The median duration of a single treatment was 7 months, and 80.5% of patients reported that the effect of treatment lasted 4 months or longer.

Durability of effect increased with successive treatments, according to 42% of the patients. There was no change in durability among 44% of the survey respondents, and 14% reported a shortened durability with successive treatments.

More than 80% of patients reported life-changing or substantial improvements in their quality of life after treatment with botulinum toxin, 14% reported some improvement, and 3% reported no improvement.

Only 6.5% of patients reported compensatory sweating elsewhere on the body, a rate similar to that of 5% reported in other studies, Dr. Rosen pointed out. This was in contrast to the 85%-90% rate of compensatory hyperhidrosis after surgical sympathectomy reported in other studies.

“That’s a big procedure and if you have compensatory hyperhidrosis elsewhere, you wouldn’t be terribly satisfied,” he said.

Dr. Rosen and his associates also looked at prognostic factors that might predict response to botulinum toxin. “People who did better with durability were those people who had sweating elsewhere, so they had more than one site of primary hyperhidrosis,” or they had failed other treatments, he said at the meeting.

In an interview, Dr. Rosen said that any treatment with a success rate greater than 90% was extraordinary. “It’s something that we as dermatologists can do where we have a lot of patient gratitude and satisfaction,” he noted. “Before we had this therapy, our other therapies were not great and people were quite desperate and had surgery, and the problem with surgery … is that they got compensatory hyperhidrosis elsewhere.”

Dr. Rosen, of Southern Suburbs Dermatology in Sydney, disclosed serving as a consultant for Allergan and Galderma unrelated to this research. No other conflicts of interest were declared.