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| |  Botulinum Toxin Effective Against Excessive Sweating CHICAGO, IL -- March 17, 1998 -- Injections of botulinum toxin can successfully eliminate excessive sweating caused by the disorder known as focal hyperhidrosis, according to an article in this month’s issue of the journal Archives of Dermatology. Markus Naumann, M.D., and colleagues from the Bayerische Julius-Maximilians-Universität, in Würzburg, Germany, studied 11 patients who underwent treatment with botulinum toxin for focal hyperhidrosis. Hyperhidrosis produces excessive sweating in the palms, feet, armpits or all three. It may produce an unpleasant body odor, which can cause social embarrassment. Treatments include anticholinergic drugs and topical applications of acids, aldehydes and metal salts, such as aluminum chloride. If these treatments prove ineffective, invasive or surgical procedures may be warranted. The researchers injected botulinum toxin type A (Botox) in the patients' palms, soles and axillae (armpits). "In all patients, botulinum toxin completely abolished sweating in the injected areas within three to seven days," they write. "Within the follow-up period of up to 20 weeks (range, 12 to 20 weeks), no clinical hyperhidrosis could be discovered in eight of 11 patients. However, 16 weeks after injection, small areas of clinically inapparent restored axillary sweating were observed in three patients, all of whom were successfully reinjected four weeks later." Botulinum toxin is a potent neurotoxin that blocks cholinergic nerve terminals. Earlier studies have shown its effect in reducing sweat production in normal volunteers. The bacterium clostridium botulinum can cause the rare, but serious form of poisoning known as botulism. All of the patients in the study were severely disabled with respect to their occupation and social activities because of the disorder. All had previously tried drug therapy, but had failed to experience any improvement in their symptoms. For all the patients, a successful treatment with botulinum toxin would provide an alternative to surgery. The researchers found that the botulinum toxin injection was well tolerated by the majority of the patients in the study. There were few adverse effects, and those that did occur were mild. Despite a marked decline in sweat production, patients with armpit sweating did not notice a significant reduction of unpleasant odor after the botulinum injection. The researchers suggest this is because of the different transmitters involved in two types of sweat glands -- one of which is unaffected by botulinum toxin. The botulinum toxin (Botox) used in the study is currently being evaluated as an orphan drug in the United States. Since it has not yet been tested sufficiently in pregnancy, in particular, the researchers say it must not be given at this stage to women of childbearing age without contraception, or to pregnant women, or nursing mothers. "Intracutaneous administration of botulinum toxin is a novel, safe and simple treatment for many patients with focal hyperhidrosis," they write. "It carries the potential to replace current invasive surgical procedures."
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