Efficacy and Safety of Botulinum Toxin Type A in Primary Axillary Hyperhidrosis: A Meta-analysis and Systematic Review.

Summary

Across 12 RCTs (n=904), botulinum toxin type A significantly reduced axillary sweat versus placebo and had fewer adverse effects compared with other treatments, while efficacy versus alternatives was similar. Study quality was appraised using Cochrane methods with subgroup and sensitivity analyses.

Key Findings

• BTX-A reduced sweat versus placebo by 116.12 (95% CI 92.68–139.57; P<0.05) on gravimetric measurement.
• Compared with other treatments, BTX-A showed no significant difference in sweat reduction (26.14 [-26.8, 79.07]; P=0.333) or HDSS (-0.85 [-1.20, 0.50]; P=0.413).
• Pain scores were comparable to other treatments (-0.41 [-1.11, 0.29]; P=0.456).
• BTX-A had fewer side effects than other treatments (0.18 [0.07, 0.43]; P<0.05).

Clinical Implications

BTX-A can be offered as an effective option for primary axillary hyperhidrosis with fewer adverse events relative to other treatments. Clinicians should discuss comparable efficacy to alternatives, potential durability, and patient-reported outcomes when selecting therapy.

Limitations

• Heterogeneity across trials and comparators may affect pooled estimates
• Limited long-term comparative data on durability and quality-of-life outcomes

Future Directions

Head-to-head RCTs with longer follow-up comparing BTX-A against alternative modalities, including cost-effectiveness and patient-reported outcomes.