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There are no good RCTs demonstrating the efficacy of botulinum toxin A for palmar hyperhidrosis. Two RCTs, one of Dysport 120 units and of Botox, comparing 50 units versus 100 units, had significant flaws in the design or analysis of the study.19,20 Therefore evidence is based on case series. The largest case series comprise 23 patients treated with Botox 50 units (half a vial)21 and 21 patients treated with Dysport 240 units (approximately half a vial) per hand.22 Vadoud-Seyedi et al.21 reported "significant improvement". Schnider et al.22 reported a median reduction of sweat production, as measured by the ninhydrin test, of 42% compared with the baseline values. The median overall satisfaction was "very good".

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