Same-patient prospective comparison of Botox versus Dysport for the treatment of primary axillary hyperhidrosis and review of literature.

BACKGROUND: Botulinum toxin (BTX) is an effective, FDA-approved treatment for primary axillary hyperhidrosis. In this prospective study, two non-bioequivalent toxins: Botox (Allergan, Irvine, CA, USA) and Dysport (Ipsen Ltd., Slough, Berkshire, UK) were compared for the treatment of primary axillary hyperhidrosis.

OBJECTIVE: The objective was to compare the injection site pain, efficacy, safety and tolerability of Botox versus Dysport in the treatment of primary axillary hyperhidrosis using a conversion factor of 1:3, respectively.

METHODS: A patient with primary axillary hyperhidrosis was treated with 100 units of Botox into the right axilla and 300 units of Dysport into the left axilla. Patient was blinded as to which axilla received treatment and with which of the two toxins. Pain at the injection site of these two toxins was evaluated. The patient was subsequently followed for the next 10 months to evaluate the difference in these two toxins in regards to side effects, time to the onset of reduction of sweating and the duration of action of these two toxins.

RESULTS: Significant difference was observed in the onset of action of these two toxins, with dramatic reduction in sweating being observed after one week of injection with Botox and after two weeks of injection with Dysport. At the two-week time point, similar success in eliminating sweating was reported in both axilla. The duration of benefits also differed between the two toxins, with elimination of sweating in the Dysport-treated axilla lasting six months and, in the Botox-treated axilla, nine months. No other differences were observed between these two toxins.

CONCLUSIONS: Both Botox and Dysport led to a similar perceived reduction of sweating in the treatment of primary axillary hyperhidrosis when a conversion factor of 1:3 was used. However, Botox treatment resulted in a quicker onset of action and longer duration of benefits.