Botulinum Toxin Type A Iontophoresis in Palmar Hyperhidrosis

Abstract

Introduction: Handshake is a form of interaction with those around us and it may be limited by palmar hyperhidrosis, a disease that has substantial impact upon affective, workplace and social relationships. This study aims to review the existing evidences about the effectiveness of botulinum toxin in the off-label treatment of palmar hyperhidrosis and consequent impact on quality of life, and also the role of iontophoresis as a drug delivery method.

Material and Methods: The expression “”botulinum toxin” AND “palmar hyperhidrosis” AND (“quality of life” OR “iontophoresis”)” was searched on PubMed, Cochrane and PEDro databases.

Results: Botulinum toxin type A, despite its cost and the transient therapeutic effect, is a valid treatment option in patients with severe sweating who have not responded to topical treatments. The benefits of using botulinum toxin type A to reduce palmar hyperhidrosis were documented in several studies and it was reported a significant improvement on quality of life after treatment. Palmar injection of botulinum toxin is however very painful. Previous studies demonstrated that botulinum toxin type A can be effectively delivered to the palms by iontophoresis with a favorable impact on quality of life.

Conclusions: Palmar hyperhidrosis can lead to embarrassing social and occupational situations as well as have a psychological impact on the patients affected. Botulinum toxin type A injection grants the reduction of sweat production on hands, but this procedure has limitations. Botulinum toxin type A iontophoresis combines a noninvasive and inexpensive delivery method with a safe and effective treatment option for palmar hyperhidrosis.

Botulinum toxin type A, even when delivered by iontophoresis, is an effective treatment option for palmar hyperhidrosis and that fact reflects positively on patients’ quality of life. Considering the established evidences, it is important to revise this unlabeled use.