The place of botulinum toxin type A in the treatment of focal hyperhidrosis

Summary Background Hyperhidrosis (primary or secondary) is excessive sweating beyond that required toreturn body temperature to normal. It can be localized or generalized, commonly affecting theaxillae, palms, soles or face, and can have a substantial negative effect on a patient’s quality of life.Impact of disease Objective evaluation comprising quantitative assessment (gravimetric and Minor’siodine starch test) and subjective evaluation (Dermatology Quality of Life Index and HyperhidrosisImpact Questionnaire) allow accurate assessment of the impact of hyperhidrosis on patients.Botulinum toxin type A Botulinum toxin type A acts by inhibiting the release of acetylcholine at thepresynaptic membrane of cholinergic neurones. It has proved useful in treating a number of dis-eases relating to muscular dystonia and is now proving beneficial in treating hyperhidrosis. Clinicaltrials investigating botulinum toxin type A use in axillary and palmar hyperhidrosis show signi-ficant benefits with few side-effects reported, with a favourable impact also being seen on patientquality of life. Botulinum toxin type A injections are generally well-tolerated with beneficial resultslasting from 4 to 16 months.Conclusions Botulinum toxin type A injections are an effective and well-tolerated treatment forhyperhidrosis. This paper proposes a positioning of this treatment along with current establishedtreatments, and highlights the role of botulinum toxin type A as a valuable therapy for thetreatment of hyperhidrosis.Key words: axillary, botulinum toxin type A, hyperhidrosis, palmar, quality of life