Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan 23:15:91-99.
doi: 10.1016/j.jdin.2023.12.011. eCollection 2024 Jun.

Botulinum toxin A versus microwave thermolysis for primary axillary hyperhidrosis: A randomized controlled trial

Gabriela Lladó Grove  1 , Katrine Togsverd-Bo  1 , Claus Zachariae  2   3 , Merete Haedersdal  1   3
Affiliations

Botulinum toxin A versus microwave thermolysis for primary axillary hyperhidrosis: A randomized controlled trial

Gabriela Lladó Grove et al. JAAD Int. .

Abstract

Background: Botulinum toxin A (BTX) and microwave thermolysis (MWT) represent 2 treatment modalities for axillary hyperhidrosis with different procedural and efficacy profiles.

Objective: To compare long-term outcomes following BTX vs MWT treatment of axillary hyperhidrosis.

Methods: A prospective, randomized, within-patient, controlled trial, treating axillary hyperhidrosis with contralateral BTX and MWT. Objective sweat measurement and patient-reported outcome measures for sweat and odor were collected at baseline, 6-month and 1-year follow-up (6M/1YFU). Hair reduction and patient treatment preference was also assessed.

Results: Sweat reduction was significant (all P <.01) for both interventions throughout the study. Objectively, sweat reduction was equal at 1-year FU (ΔP =.4282), but greater for BTX than MWT at 6-month FU (ΔP =.0053). Subjective sweat assessment presented comparable efficacy (6MFU: ΔP =.4142, 1YFU: ΔP =.1025). Odor reduction was significant (all P <.01) following both interventions, whereas only sustaining for MWT (6MFU: ΔP =.6826, 1YFU: ΔP =.0098). Long-term, hair reduction was visible after MWT, but not BTX (ΔP ≤.0001), and MWT was preferred by the majority of patients (76%).

Limitations: The intrinsic challenges in efficacy assessment.

Conclusion: This study exhibited BTX and MWT with similar sweat reduction, but distinguishable odor and hair reduction at 1-year FU. These findings support individualized treatment approaches for axillary hyperhidrosis based on patient-specific symptoms and preferences.

Keywords: PROMs; QoL; RCT; botulinum toxin; bromhidrosis; hyperhidrosis; individualized treatment; microwave thermolysis; osmidrosis; personalized therapy; randomized controlled trial.

PubMed Disclaimer

Conflict of interest statement

Dr Haedersdal has received speaker honorarium for microwave thermolysis symposium. Drs Grove, Togsverd-Bo, and Zachariae have no conflicts of interest to declare.

Figures

Fig 1
Fig 1
Patient-reported outcome measures assessment scales.
Fig 2
Fig 2
Sweat intensity visualized by starch-iodine test at baseline and 1-year following botulinum toxin A and microwave thermolysis in 1 study patient.
Fig 3
Fig 3
Axillary hair growth 1-year following botulinum toxin A and microwave thermolysis (MWT); examples of visible hair reduction in 3 study patients with (A) light, (B) moderate, and (C) severe hair reduction on the MWT-treated axilla.
Fig 4
Fig 4
Subjective measures of sweat, odor, and quality of life at baseline, 6-months and 1-year following botulinum toxin A and microwave thermolysis, presented with medians (IQR) and ΔP values.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Nawrocki S., Cha J. The etiology, diagnosis, and management of hyperhidrosis: a comprehensive review: Etiology and clinical work-up. J Am Acad Dermatol. 2019;81(3):657–666. doi: 10.1016/j.jaad.2018.12.071. - DOI - PubMed
    1. He J., Wang T., Dong J. A close positive correlation between malodor and sweating as a marker for the treatment of axillary bromhidrosis with botulinum toxin A. J Dermatolog Treat. 2012;23(6):461–464. doi: 10.3109/09546634.2011.594869. - DOI - PubMed
    1. Thorlacius L., Gyldenløve M., Zachariae C., Carlsen B.C. Distinguishing hyperhidrosis and normal physiological sweat production: new data and review of hyperhidrosis data for 1980-2013. Int J Dermatol. 2015;54(10):e409–e415. doi: 10.1111/ijd.12822. - DOI - PubMed
    1. Nawrocki S., Cha J. The etiology, diagnosis, and management of hyperhidrosis: a comprehensive review: Therapeutic options. J Am Acad Dermatol. 2019;81(3):669–680. doi: 10.1016/j.jaad.2018.11.066. - DOI - PubMed
    1. Naumann M., Lowe N.J. Botulinum toxin type A in treatment of bilateral primary axillary hyperhidrosis: randomised, parallel group, double blind, placebo controlled trial. BMJ. 2001;323(7313):596–599. doi: 10.1136/bmj.323.7313.596. - DOI - PMC - PubMed

LinkOut - more resources