Original article
Duration of efficacy increases with the repetition of botulinum toxin A injections in primary palmar hyperhidrosis: A study of 28 patients

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Background

Intradermal injections of botulinum toxin are effective but transitory in primary palmar hyperhidrosis. These injections are repeated when the symptoms recur. We do not know how the duration of efficacy changes when injections are repeated.

Objective

In this retrospective study, we aimed to investigate the change in the duration of efficacy of botulinum toxin A (Dysport, Ipsen, Boulogne-Billancourt, France) with the repetition of injections in patients with primary palmar hyperhidrosis.

Methods

From May 2001 to April 2012, 28 patients were treated with a dose of 250 U of botulinum toxin A per palm. We compared the duration of efficacy of the first and last toxin injections.

Results

The median duration of efficacy was 7 months for the first injection and 9.5 months for the last, the difference being statistically significant (P = .0002).

Limitations

Study limitations include a relatively small number of patients treated at a single center and evaluated retrospectively.

Conclusion

To our knowledge, this study is the first to report a significant increase in the duration of efficacy of botulinum toxin A injections with the repetition of injections in patients with primary palmar hyperhidrosis. The reasons for this effect may be linked to the mechanism of action of botulinum toxin, and may improve our understanding of its pharmacologic effects.

Section snippets

Methods

We included all eligible patients followed up for primary palmar hyperhidrosis and seen between May 2001 and April 2012 in dermatology consultations at Le Mans Hospital in France for treatment with botulinum toxin.

All the patients had experienced failure for first-line treatment with antiperspirants based on aluminum salts with concentration at 20% and/or iontophoresis, with major psychosocial repercussions.

All these patients had palmar hyperhidrosis detected by Minor test.16 In this test, 2 g

Results

We included 28 patients, 17 female and 11 male, aged from 17 to 73 years, between May 2001 and April 2012. The median duration of efficacy was 7 months for the first injection and 9.5 months for the last injection (Fig 2). The difference between these 2 values was statistically significant (P = .0002; Wilcoxon matched pair tests). The patients underwent a mean of 4 injection sessions: 24 patients (86%) had 2 to 5 sessions, 2 patients had 6 sessions, 1 patient had 8 sessions, and 1 patient had

Discussion

Many studies have demonstrated the efficacy and safety of botulinum toxin use in the treatment of primary palmar hyperhidrosis,9, 12, 13, 14, 19, 20, 21, 22, 23 but our study is the first to our knowledge to suggest an increase in the duration of efficacy of botulinum toxin for palmar hyperhidrosis with repetition of injections.

This treatment improves the patient's quality of life,23 which is often affected because of major socioprofessional consequences of this condition. The major drawback of

Conclusion

To our knowledge, our study is the first to suggest an increase in the duration of efficacy of botulinum toxin A for primary palmar hyperhidrosis with the repetition of injections, and in axillary hyperhidrosis.37 This is supported by a statistically significant increase in the duration of efficacy with the repetition of injections from a retrospective review of 28 patients with primary palmar hyperhidrosis seen between May 2001 and April 2012 in dermatology consultations at Le Mans Hospital,

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  • Cited by (0)

    Funding sources: None.

    Conflicts of interest: None declared.

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