INTRODUCTION
Primary hyperhidrosis (PH) is an idiopathic, chronic disorder characterized by uncontrolled sweat production exceeding that required for homeostasis maintenance.1 Typically in a bilateral and symmetrical pattern, PH can affect different areas of the body, most commonly axillae, palms, soles, and face, with affected patients often sweating from one or two areas of the body.2 The prevalence of PH is widely variable in the literature. In the U.S., a survey with 150,000 households estimated a national prevalence of 2.8%,3 while a more recent study reported the prevalence of hyperhidrosis at 4.8%.4 Of the affected population, more than half of the patients have axillary hyperhidrosis (AH).3,4
AH affects both genders, and symptoms usually manifest during puberty or adolescence.5 It is an emotionally, physically and socially distressing condition that interferes with everyday activities and exerts a negative impact on patients’ quality of life.6,7 Given the burden of excessive sweating, reduction of sweat production is an important goal of management and treatment of AH.8 Botulinum toxin A (BoNT-A) has proven to be an effective and safe treatment for primary AH, promoting high levels of satisfaction among patients.9-11 This treatment can temporarily inhibit excessive sweating by blocking the release of the neurotransmitter acetylcholine, producing efficient chemical gland denervation. It is a minimally invasive procedure that can be administered in outpatient facilities under topical, local, or locoregional anesthesia. Incobotulinumtoxin A (IncoA, Xeomin®, Merz Pharma) was shown to have similar efficacy and safety profiles as onabotulinumtoxin A (Botox®, Allergan).12
For AH, BoNT-A is typically applied by multiple (usually 10 to 20) intradermal injections of small doses per point, spaced 1–2cm apart, to cover the affected area.8,11 Overall, it is an easy, simple and well tolerated procedure. An alternative injection technique involving the use of a more diluted solution (Dr. Rosa Flores, Mexico, personal communication based on Odderson13) injected subcutaneously in a radial manner through two points of entrance has been proposed with the aim of reducing procedure duration. However, its efficacy and safety have not
AH affects both genders, and symptoms usually manifest during puberty or adolescence.5 It is an emotionally, physically and socially distressing condition that interferes with everyday activities and exerts a negative impact on patients’ quality of life.6,7 Given the burden of excessive sweating, reduction of sweat production is an important goal of management and treatment of AH.8 Botulinum toxin A (BoNT-A) has proven to be an effective and safe treatment for primary AH, promoting high levels of satisfaction among patients.9-11 This treatment can temporarily inhibit excessive sweating by blocking the release of the neurotransmitter acetylcholine, producing efficient chemical gland denervation. It is a minimally invasive procedure that can be administered in outpatient facilities under topical, local, or locoregional anesthesia. Incobotulinumtoxin A (IncoA, Xeomin®, Merz Pharma) was shown to have similar efficacy and safety profiles as onabotulinumtoxin A (Botox®, Allergan).12
For AH, BoNT-A is typically applied by multiple (usually 10 to 20) intradermal injections of small doses per point, spaced 1–2cm apart, to cover the affected area.8,11 Overall, it is an easy, simple and well tolerated procedure. An alternative injection technique involving the use of a more diluted solution (Dr. Rosa Flores, Mexico, personal communication based on Odderson13) injected subcutaneously in a radial manner through two points of entrance has been proposed with the aim of reducing procedure duration. However, its efficacy and safety have not
