And now Botox as an antiperspirant

Injecting the wrinkle buster can reduce excessive perspiration. Never let them see you sweat

By Henry Peters

Hyperhidrosis, or excessive sweating, is one of those diseases that seem quite funny unless you have it. As a socially embarrassing condition, it is also the type of disease whose prevalence is most likely to be underestimated. A recent American study, however, found that the condition actually affects about 2.8% of the population. Among sufferers, one in three said their sweating was intolerable or barely tolerable. Many said they were depressed and frustrated with daily activities, that the condition interfered with work and romance, and many found it hard meeting people.

Now, a phase III clinical study using botulinum toxin type A, better known as Botox, has been found safe and effective in the treatment of primary axillary hyperhidrosis. The findings were presented by Dr Anna Glaser, a dermatologist at Saint Louis University School of Medicine, to the American Academy of Dermatology's annual meeting.

"It's important for people to realize that hyperhidrosis is not a mild nuisance that just a few people experience, " said Dr Glaser. "This is a big problem that does not get better without proper treatment and can really be debilitating for those affected by it. "

"Our studies have found that patients with hyperhidrosis produced four to five times the amount of sweat as those without the condition, " she said. "Men with hyperhidrosis, for example, produced an average of 346 milligrams of sweat per five minutes, as compared to men sweating normally, who produced 72 milligrams. "

Hyperhidrosis generally first occurs during puberty and early adolescence. In a society where you must "never let them see you sweat, " it can cause significant anxiety, especially in young people. The seriousness with which some patients view the condition may be measured by the rather drastic and time-consuming treatments sometimes used. These include anticholinergics, sweat gland resection and endoscopic transthoracic sympathectomy (ETS). Another approach, an electrical treatment called iontophoresis, is time-consuming and must be continued indefinitely, sometimes on a weekly or even daily basis.

The trial of botulinum toxin type A, sponsored by Allergen Inc., involved 322 patients randomized into treatment and placebo arms over a four-week period. It was found that 75% of patients receiving botulinum toxin type A compared to 25% of those on placebo achieved at least a 2-point improvement from baseline on the Hyperhidrosis Severity Scale (HDSS), a 4-point scale. Quantity of sweat production in the axillae was also significantly decreased.

Upon completion of the study, 85% of patients treated with botulinum reported that they were much more satisfied with the current study treatment than with previous treatments, versus 20% of patients on placebo. The drug is injected into the problem site, and follow-up of this study group suggests the treatment would have to be repeated every six to nine months.

Botulinum toxin type A is best known for unwrinkling the hoary Hollywood set, but the neuromuscular blocking agent is mainly used as a treatment for muscle spasms.