Comparing Injection Techniques of Botulinum Toxins for Axillary Hyperhidrosis

The study found that both multiple-puncture injection and radial injection of incobotulinumtoxinA are effective and safe for treating AH, but the multiple-puncture injection technique is less painful and more effective, at some time points.

Comparison of incobotulinumtoxinA (Xeomin) injection techniques for treating axillary hyperhidrosis
Comparison of incobotulinumtoxinA (Xeomin) injection techniques for treating axillary hyperhidrosis

A comparison study of two incobotulinumtoxinA injection techniques for treating axillary hyperhidrosis found that the traditional multiple injection point technique is less painful and, at certain time points, more effective than radial injections with only two entry points.

Presented as a poster at TOXINS 2021 in January, the randomized, evaluator-blinded study by Brazilian researchers Ada Regina Trindade de Almeida, et al, included 24 subjects (mean age 34.7 years) with severe hyperhidrosis. Each patient received 50 U of incobotulinumtoxinA (Xeomin) injected intradermally using multiple punctures in one axilla and the same amount injected subcutaneously by radial approach in the other axilla. The blinded evaluators assessed outcomes at 30, 120, 180 and 270 days post treatment. Procedure duration and subject-rated pain were also assessed.Radial (A) and multiple puncture injection (B) techniques used in the study.Radial (A) and multiple puncture injection (B) techniques used in the study.

The two-point radial injection technique was faster than the multiple injection technique (70.7 ± 26.4 seconds vs. 131.5 ± 39 seconds) but more painful (5.9 ± 2.1 pain score vs. 4.4 ± 2.0). Both techniques yielded significant sweat reduction, with 95% of subjects responding (50% or greater sweat reduction from baseline) after 30 days.

Most subjects had an excellent response (90%-100% sweat reduction) after 30 days that was sustained until at least day 270 with both techniques. The multiple-puncture group had a higher reduction in gravimetric measures at days 30 and 180 and Minor’s test at day 270.

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