Botulinum Toxin Type A for Treatment of Forehead Hyperhidrosis: Multicenter Clinical Experience and Review from Literature

Abstract

Among the forms of idiopathic hyperhidrosis, those involving the forehead have the greatest impact on patients' quality of life, as symptoms are not very controllable and are difficult to mask for patients. Although the local injection therapy with Incobotulinum toxin type A (IncoBTX-A therapy) can be considered a rational treatment, data from the literature describing both efficacy and safety of the treatment over the long term are poor. The aim of this report is to describe the single-center experience of five patients seeking treatment, for forehead hyperhidrosis with IncoBTX-A. To evaluate the benefits, safety profile and duration of anhidrosis, patients were treated following a standardized procedure and then followed until clinical relapse. The amount of sweating was measured by gravimetric testing, the extension of hyperhidrosis area was measured through Minor's iodine starch test, and response to the treatment was evaluated using the Hyperhidrosis Disease Severity Scale (HDSS) and the Dermatology Life Quality Index (DLQI). In all treated patients, a significant anhidrotic effect was observed 4 weeks after the treatment and lasted for approximately 36 weeks. The reduction in sweat production was associated with significant amelioration of symptoms and quality of life for all treated patients. No serious side effects occurred; one patient complained of a mild transient bilateral ptosis. Although further wider studies are required, our preliminary results seem to encourage the use of IncoBTX-A in forehead hyperhidrosis.

Keywords: DLQI; HDSS; Incobotulinum toxin type A; efficacy; forehead hyperhidrosis; gravimetric test; quality of life; safety.

Figure 1

Effect of IncoBTX-A injection on forehead hyperhidrosis on five patients (a) Minor’s iodine starch test in all patients at baseline; (b) configuration of the pre-operative treatment grid in all patients; (c) effect of treatment on sweat production documented through minor’s iodine starch test 4 weeks after treatment in all treated patients.

Figure 2

Sweat production before (baseline) and 4 weeks after treatment with IncoBTX-A. * p = 0.009. Squares are single values of sweat production for patients after treatment.

Figure 3

Minor’s iodine starch test before, after IncoBTX-A and at clinical observation point during follow up. ** p = 0.004. Solid blocks are single values of sweat production for patients after treatment.

Figure 4

HDSS before, after IncoBTX-A and at clinical observation points during follow up. * p = 0.001. Solid black circles are single values of sweat production for patients after treatment.

Figure 5

DLQI before, after IncoBTX-A and at clinical observation point during follow up. *** p = 0.0007; ** p = 0.02. Solid black circles, squares strangles and all other symbols are all single values of DLQI through time-points.