Clinical utility of botulinum toxin type A local injection therapy for head and forehead hyperhidrosis

A novel lotion formulation of 20% oxybutynin hydrochloride for the treatment of primary palmar hyperhidrosis: A randomized, placebo-controlled, double-blind, phase III study

BACKGROUND

No previous controlled studies have been specifically designed or adequately powered to show the efficacy of topical oxybutynin for palmar hyperhidrosis by using quantitative measures.

OBJECTIVE

To evaluate efficacy of 20% oxybutynin hydrochloride lotion (20% OL) in reducing palmar sweat volume in patients with primary palmar hyperhidrosis (PPHH).

METHODS

In a randomized controlled trial, Japanese patients with PPHH aged 12 years and older received either 20% OL (n = 144) or placebo (n = 140) on both palms once daily for 4 weeks. Palmar sweat volume was measured by the ventilated capsule method. For the primary outcome, response was defined as a reduction of sweat volume of at least 50% from baseline.

RESULTS

At week 4, the responder rate for sweat volume was significantly higher in the 20% OL arm than in the placebo arm (52.8% vs 24.3%, respectively; treatment difference, 28.5% [95% CI, 17.7% to 39.3%]; P < .001). No serious adverse events occurred, and no adverse events led to treatment discontinuation.

LIMITATIONS

The treatment period was only 4 weeks.

CONCLUSIONS

In patients with PPHH, 20% OL is superior to placebo in reducing palmar sweat volume.

The Impact of Hyperhidrosis on Quality of Life: A Review of the Literature

Hyperhidrosis is a condition of excessive sweating, which can have profound physical and mental effects. Hyperhidrosis is a significantly impactful and distressing illness that warrants equal attention as other more well-known dermatologic conditions. However, because of a lack of awareness among the public, stigma, and difficulty with access to treatments (due to cost or insurance coverage), patients are less likely to be diagnosed and treated. In hyperhidrosis, quality-of-life surveys can be useful for determining the magnitude of symptoms and to evaluate treatment outcomes. The purpose of this study was to conduct a narrative literature review to investigate the impact of hyperhidrosis on quality of life. A total of 49 articles investigating the impact of primary hyperhidrosis on quality of life were selected for the review. Hyperhidrosis is a potentially debilitating illness that affects multiple domains of patients' lives including their psychological, physical, and social functioning. Despite the significant impacts, patients with hyperhidrosis are less likely to seek care. Here, we explore these impacts, and disparities in care, in more detail.

Intradermal Botulinum Toxin A Injection for Scalp Sebum Secretion Regulation: A Multicenter, Randomized, Double-Blinded, Placebo-Controlled, Prospective Study in Chinese Subjects

BACKGROUND

Although botulinum toxin type A (BTX-A) injection has been proved to reduce topical sebum secretion, the impact of intradermal BTX-A injection on scalp sebum production has never been reported.

OBJECTIVES

The purpose of this study was to investigate the efficacy and safety of intradermal BTX-A treatment vs intradermal normal saline (NS) injection for scalp sebum secretion regulation.

METHODS

This multicenter, randomized, double-blinded, prospective study recruited patients complaining of oily scalp and/or hair. The patients were randomly allocated to receive either 1 session of intradermal BTX-A or NS injection. The baseline and posttreatment scalp sebum secretion at 24, 48, 72, and 96 hours postshampooing was measured with a Sebumeter SM815 (Cutometer Dual MPA 580, Courage & Khazaka, Cologne, Germany) at 1, 3, 4, and 6 months after treatment. The patients' comments, satisfaction, and adverse events were evaluated and compared.

RESULTS

In total, 25 patients in the BTX-A group and 24 patients in the NS group completed the follow-up. For the treated region, compared with NS, intradermal BTX-A treatment (50-65 U) significantly reduced scalp sebum secretion at 24, 48, and 72 hours postshampooing at the 1- and 3-month follow-up visits (P < 0.05). No significant difference between the 2 groups was observed at 4 and 6 months after the treatment. The patients' satisfaction ratings were significantly higher for the BTX-A treatment (P = 0.000). No serious adverse events occurred.

CONCLUSIONS

Compared with NS, 1 session of intradermal BTX-A injection (50-65 U) effectively and safely reduced scalp sebum secretion and greasiness perception in the treated region at 24 and 48 hours postshampooing for 3 months.

LEVEL OF EVIDENCE: 4

Botulinum Toxin Type A for Treatment of Forehead Hyperhidrosis: Multicenter Clinical Experience and Review from Literature

Among the forms of idiopathic hyperhidrosis, those involving the forehead have the greatest impact on patients’ quality of life, as symptoms are not very controllable and are difficult to mask for patients. Although the local injection therapy with Incobotulinum toxin type A (IncoBTX-A therapy) can be considered a rational treatment, data from the literature describing both efficacy and safety of the treatment over the long term are poor. The aim of this report is to describe the single-center experience of five patients seeking treatment, for forehead hyperhidrosis with IncoBTX-A. To evaluate the benefits, safety profile and duration of anhidrosis, patients were treated following a standardized procedure and then followed until clinical relapse. The amount of sweating was measured by gravimetric testing, the extension of hyperhidrosis area was measured through Minor’s iodine starch test, and response to the treatment was evaluated using the Hyperhidrosis Disease Severity Scale (HDSS) and the Dermatology Life Quality Index (DLQI). In all treated patients, a significant anhidrotic effect was observed 4 weeks after the treatment and lasted for approximately 36 weeks. The reduction in sweat production was associated with significant amelioration of symptoms and quality of life for all treated patients. No serious side effects occurred; one patient complained of a mild transient bilateral ptosis. Although further wider studies are required, our preliminary results seem to encourage the use of IncoBTX-A in forehead hyperhidrosis.