Toxins 2013, 5(4), 821-840; doi:10.3390/toxins5040821
Review

Hyperhidrosis: Anatomy, Pathophysiology and Treatment with Emphasis on the Role of Botulinum Toxins

1 Department of Neurology, Yale University School of Medicine; New Haven, CT 06520, USA 2 Department of Neurology, Case Western Reserve University; Cleveland, OH 44106, USA
* Author to whom correspondence should be addressed.
Received: 12 February 2013; in revised form: 27 March 2013 / Accepted: 12 April 2013 / Published: 23 April 2013
(This article belongs to the Special Issue Neurotoxins: Health Threats and Biological Tools)
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Abstract: Clinical features, anatomy and physiology of hyperhidrosis are presented with a review of the world literature on treatment. Level of drug efficacy is defined according to the guidelines of the American Academy of Neurology. Topical agents (glycopyrrolate and methylsulfate) are evidence level B (probably effective). Oral agents (oxybutynin and methantheline bromide) are also level B. In a total of 831 patients, 1 class I and 2 class II blinded studies showed level B efficacy of OnabotulinumtoxinA (A/Ona), while 1 class I and 1 class II study also demonstrated level B efficacy of AbobotulinumtoxinA (A/Abo) in axillary hyperhidrosis (AH), collectively depicting Level A evidence (established) for botulinumtoxinA (BoNT-A). In a comparator study, A/Ona and A/Inco toxins demonstrated comparable efficacy in AH. For IncobotulinumtoxinA (A/Inco) no placebo controlled studies exist; thus, efficacy is Level C (possibly effective) based solely on the aforementioned class II comparator study. For RimabotulinumtoxinB (B/Rima), one class III study has suggested Level U efficacy (insufficient data). In palmar hyperhidrosis (PH), there are 3 class II studies for A/Ona and 2 for A/Abo (individually and collectively level B for BoNT-A) and no blinded study for A/Inco (level U). For B/Rima the level of evidence is C (possibly effective) based on 1 class II study. Botulinum toxins (BoNT) provide a long lasting effect of 3–9 months after one injection session. Studies on BoNT-A iontophoresis are emerging (2 class II studies; level B); however, data on duration and frequency of application is inconsistent.
Keywords: botulinum neurotoxins; hyperhidrosis; iontophoresis; double blind; axillary; palmar; gustatory; compensatory; topical agents; oral agents

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MDPI and ACS Style

Lakraj, A.-A.D.; Moghimi, N.; Jabbari, B. Hyperhidrosis: Anatomy, Pathophysiology and Treatment with Emphasis on the Role of Botulinum Toxins. Toxins 2013, 5, 821-840.

AMA Style

Lakraj A-AD, Moghimi N, Jabbari B. Hyperhidrosis: Anatomy, Pathophysiology and Treatment with Emphasis on the Role of Botulinum Toxins. Toxins. 2013; 5(4):821-840.

Chicago/Turabian Style

Lakraj, Amanda-Amrita D.; Moghimi, Narges; Jabbari, Bahman. 2013. "Hyperhidrosis: Anatomy, Pathophysiology and Treatment with Emphasis on the Role of Botulinum Toxins." Toxins 5, no. 4: 821-840.

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