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There is no systematic review. Besides a small RCT that demonstrated the efficacy of 200 units of botulinum toxin A (Dysport),12 two large

RCTs have demonstrated the efficacy of this treatment in axillary hyperhidrosis. Heckmann et al.6 investigated the efficacy of botulinum toxin A 200 units (two-fifths of a vial Dysport) in 145 participants with axillary hyperhidrosis. After 2 weeks the rate of sweating was reduced below 25 mg/minute in 64-8% of the axillae treated with botulinum toxin compared with 1-4% of the axillae treated with placebo. At least 50% reduction in sweating (compared with baseline) could be achieved in 134/145 of the axillae treated with botulinum toxin and 22/145 of the axillae treated with placebo. Based on this data, the numbers needed to treat (NNT) can be calculated as 1-3 to 1 (i.e. from four patients treated with 200 units Dysport, three patients will obtain at least a 50% reduction in sweating). In another RCT, 320 patients with axillary hyperhidrosis were treated with 50 units of a different strain of botulinum toxin A (half a vial of Botox). After 3 weeks, 95% (95% confidence intervals 91-5 to 97-4) in the active-treatment group and 32-1% (21-9, 43-6) in the placebo group reported at least a 50% reduction in sweating.7 Based on this data the NNT for 50 units Botox can be calculated as 1-7 to 1 (of four patients treated, two would obtain at least a 50% reduction in sweating).

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