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The comparative effectiveness of suction-curettage and onabotulinumtoxin-A injections for the treatment of primary focal axillary hyperhidrosis: A randomized control trial - 14/06/13

Doi : 10.1016/j.jaad.2013.02.013 
Omer Ibrahim, MD a, d, e, Rohit Kakar, MD a, Diana Bolotin, MD, PhD a, Michael Nodzenski, BA a, Wareeporn Disphanurat, MD a, Natalie Pace, BS a, Lauren Becker, MD a, Dennis P. West, PhD a, Emily Poon, PhD a, Emir Veledar, PhD f, Murad Alam, MD, MSCI a, b, c,
a Department of Dermatology, Northwestern University, Chicago, Illinois 
b Department of Otolaryngology–Head and Neck Surgery, Northwestern University, Chicago, Illinois 
c Department of Surgery, Northwestern University, Chicago, Illinois 
d Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut 
e Department of Dermatology, Cleveland Clinic Foundation, Cleveland 
f Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 

Reprint requests: Murad Alam, MD, MSCI, Department of Dermatology, Northwestern University, 676 N St Clair St, Suite 1600, Chicago, IL 60611.

Abstract

Background

Botulinum toxin injections and suction-curettage have been separately shown to be effective in treating axillary hyperhidrosis but have not been compared in the same patients.

Objective

We sought to compare effectiveness of suction-curettage versus neurotoxin for the treatment of axillary hyperhidrosis.

Methods

Each of 20 patients was randomized to receive toxin injections to one axilla and suction-curettage to the contralateral axilla. The primary outcome measure was reduction of sweat rate measured by gravimetry, and the secondary measure was quality of life as measured by a patient-directed questionnaire.

Results

At 3 months posttreatment, toxin injections decreased baseline resting sweat production by 72.1% versus 60.4% (P = .29) for suction-curettage, and baseline exercise-induced sweat production by 73.8% versus 58.8% (P = .10). When patients were stratified into the categories of light and heavy sweaters, there was a difference among heavy sweaters, with exercise-induced sweat production lower by 10.48 mg/min or 34.3% (P = .0025) at toxin-treated sites. Compared with suction-curettage, toxin also resulted in greater improvements in quality of life by 0.80 points (P = .0002) and 0.90 points (P = .0017) at 3 and 6 months posttreatment, respectively, as measured by the patient questionnaire.

Limitations

The follow-up period was limited to 6 months.

Conclusions

By objective measures 3 months after treatment, neurotoxin injections are nominally more effective than suction-curettage in all cases, and markedly more effective in heavy sweaters. Patients have a very significant preference for neurotoxin injections at 3 months, and this is maintained at 6 months.

Le texte complet de cet article est disponible en PDF.

Key words : axillary hyperhidrosis, botulinum, gravimetry, onabotulinum, suction, suction-curettage, underarm sweating


Plan


 Funded by the Department of Dermatology, Northwestern University. No funding or product was received from Allergan (manufacturer of Botox).
 Disclosure: Drs Alam and West have been investigators for other studies with Allergan (Botox), but no compensation was received by them from these earlier, unrelated studies. Drs Ibrahim, Kakar, Bolotin, Disphanurat, Becker, Poon, and Veledar; Mr Nodzenski; and Ms Pace have no conflicts of interest to declare.


© 2013  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 69 - N° 1

P. 88-95 - juillet 2013 Retour au numéro
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