الفهرس 
Botulinum ToxinOnly 14 pages are availabe for public view
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Abstract
P
rimary palmar hyperhidrosis is a common disorder affecting 2-4% of the population, characterized by excessive sweating of the palmar surface of the hands induced by sympathetic hyperactivity. The condition affects both the professional and the personal life of the individual, leading to serious social and psychological disablement.
Botulinum toxin type Ais considered to be an effective and safe treatment for patients with PPH. It is generally well tolerated with minimal side effects. In addition, it is considered to be a good treatment option for patients who couldn’t tolerate the side effects of other treatment modalities, or there ineffectiveness, impracticality and short duration of cure. The main advantages of BTX-A is;cessation of sweating lasts for months, it is an easy therapeutic technique and its minimal and tolerable side effects.
There is increasing evidence that the efficacy of BTX-A on sweating results from thefact that it binds presynaptically to the high affinity recognition sites on the cholinergic nerve terminals thus decreasing the release of acetylcholine (ACh.) resulting in the neuromuscular blocking effect.
Currently different formulations of BTX-A are available, however they are not identical in their potencies and may behave differently in clinical practice. The two brands of BTX-A tested in the present study, Dysport and BOTOX, are the most commonly used in the world. Even after 15 years of clinical use, the unit equivalence between them is still a matter of discussion.
This single-blind, comparative study was carried out to evaluate and compare the efficacy and adverse effects of Botox and Dysport in treating PPH. A conversion factor between Botox and Dysport of 1:2.5 respectively was used.
Eight patients were recruited to this study suffering from severe PPH. Each patient was injected intradermally by both preparations, one type in each palm in the same visit. The right palm was injected with Botox, while the left palm was injected with Dysport. All patients were followed up for 8 months; quantification of sweat production was performed by Minor’s iodine starch test and evaluating QOLimpairment caused by the disease was assessed before and after treatment by Dermatology Life Quality Index (DLQI).
In the present study, a highly significant decrease in sweating was detected after treatment in both palms(being more in the left palm as compared to the right one in the 1st follow up visit) of all patients, regardless the type of BTX-A used. Meanwhile, sweating reduction was similar in both palms in the rest of all follow up visits.
Moreover, on comparing Botox (injected in the right palm) with Dysport (injected in the left palm) as regards their complications (in the form of hand grip weakness, heaviness and tingling that resolved within 3 weeksspontaneously) a non significant difference between them was noted. All patients experienced a dramatic QOL improvement after treatment insuring the efficacy of BTX-A in treating PPH.
In our study, 25% relapse started to appear in patients after 8 months of the injection procedure in both palms. We also detected that the disease duration is directly related to the occurrence of relapse, that is to say that patients with longer disease duration period were found to be more liable to relapse.
In conclusion, BTX-A is an effective modality in treating cases suffering from primary palmar hyperhidrosis (PPH). It’s also safe as it has minimal and reversible side effects. Botox and Dysport presented similar levels of efficacy and safety in the treatment of PPH when a conversion factor of 1:2.5 was used. However, there was a trend towards a larger improvement after Dysport treatment initially but didn’t reach statistical significance. Finally, since it was detected that the disease duration is directly related to the occurrence of relapse,treatment should be started early to get better outcomes with longer period of cure.