Topical Botulinum Toxin Type A Liposomal Cream for Primary Axillary Hyperhidrosis: A Double-Blind, Randomized, Split-Site, Vehicle-Controlled Study

BACKGROUND Despite its effectiveness in treating primary axillary hyperhidrosis (PAH), topical botulinum toxin type A (BTX-A) is highly resistant to transdermal absorption. Topical BTX-A liposomal cream is recommended as a novel, noninvasive modality to enhance skin penetration. OBJECTIVE To evaluate the efficacy and safety of topical BTX-A liposomal cream in comparison with liposomal vehicle cream alone in the treatment of PAH. MATERIALS AND METHODS A prospective, randomized, double-blinded, split-site study was conducted in 20 subjects, aged 18 to 50 years, all of whom had symmetrical axillary sweating with Hyperhidrosis Disease Severity Scale scores between 2 to 4. All subjects were double-blinded to treatment regimens and randomly given 2 bottles, one containing topical BTX-A liposomal cream and one containing the vehicle cream without BTX-A, to be applied consistently to the same axilla nightly for 7 consecutive days. Clinical improvement and adverse reactions were evaluated at every follow-up visit. RESULTS Axillary skin treated with topical BTX-A demonstrated superior sweat reduction and patient satisfaction to vehicle cream–treated axillary skin, with clinical and statistical significance, at baseline, weeks 2, 4, 6, and 8 of follow-up, without adverse effects. CONCLUSION Topical BTX-A liposomal cream pharmaceutically enhances drug delivery, is painless, cost-effective, and overall an innovative treatment of PAH. Address correspondence and reprint requests to: Suparuj Lueangarun, MD, MSc, Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, 99 Moo 18 Phahonyothin Rd Klonglung, Pathum Thani, Thailand 12120, or e-mail: saoraya180@gmail.com The authors have indicated no significant interest with commercial supporters. S. Lueangarun and C. Sermsilp were responsible for the initiation, execution, data collection, analysis, and drafting of the paper. S. Lueangarun and T. Tempark were responsible for the critical revision of the manuscript as well as the review and approval of the final paper. © 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

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