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Botulinux Toxins – Friend of Hyperhidrosis or Foe?


Botulinum toxin is a neurotoxin type protein and is the most toxic protein known to man. However, it has several clinical uses including treatment of hyperhidrosis, particularly of the axillary type. There are also a number of types of botulinum toxin and whilst type A is the most commonly used, the others also have promise and studies have been carried out to compare their efficacy.

Botulinum Toxin Type A (BTX-A)

Also known by the brand name “Botox”, this drug has FDA approval for treatment of axillary hyperhidrosis and several studies have shown a dose of between 50 and 100 U per axilla to be effective[1][2]. It has also been successfully used for palmar hyperhidrosis with a recommended dose of between 50 and 100 U per hand[3]. However it can rarely cause the side effect of temporary weakness in the thumb if used for this purpose[4].

Other Botulinum Toxin Types

There are a number of other types of this toxin ranging from B through to G. Very rarely, a person may have an immune resistance to type A and another type could be beneficial in such cases. Although only type A has FDA approval for treatment of hyperhidrosis, clinical trials have been carried out to comparing the efficacy of all types.

Type B, also known as Neurobloc, is known to be effective in humans only at high doses and type F has a much shorter action compared to the baseline type A and is therefore not suitable for treatment of hyperhidrosis. One study showed that types B (in an increased dose) and type C have a similar profile to type A and could be used as alternatives[5]. However, type B has been shown to have greater autonomic side effects than type A such as dryness of the mouth and eye irritation[6].

Animal studies indicate that type A has the longest action of all the types and given the low number of side effects or complications it is preferable. The next longest acting types are B, F and E[7].

Conclusion

Unless there is the presence of immune resistance, botulinum toxin type A should be used for treatment of axillary and palmar hyperhidrosis. It is highly tolerated and if used in the recommended doses causes few side effects.

In the case of such immune resistance, type B can be used instead.

1. http://www.bmj.com/cgi/content/abstract/323/7313/596
2. http://derm.jwatch.org/cgi/content/full/2002/529/2
3. http://www.neurology.org/cgi/content/abstract/57/11/2095
4. http://www.ncbi.nlm.nih.gov/pubmed/10827408
5. http://www3.interscience.wiley.com/journal/107633255/abstract?CRETRY=1&SRETRY=0
6. http://content.karger.com/produktedb/produkte.asp?typ=fulltext&file=ene49034
7. http://tinyurl.com/95k9ar