Efficacy of Onabotulinum Toxin A (Botox) versus Abobotulinum Toxin A (Dysport) Using a Conversion Factor (1？:？2.5) in Treatment of Primary Palmar Hyperhidrosis
Background. Two preparations of botulinum A toxin (BTX-A) are commercially available for the treatment of palmar hyperhidrosis (PPH): Botox (Allergan; 100？U/vial) and Dysport (Ipsen Limited; 500？U/vial), which are not bioequivalent. Results regarding an appropriate conversion factor between them are controversial. Objectives. This paper aims to compare the efficacy of Botox and Dysport in PPH using a conversion factor of 1？:？2.5. Methods. Eight patients with severe PPH received intradermal injections of Botox in one palm and Dysport in the other in the same session. Clinical assessment was performed at baseline and posttreatment for 8 months using Minor’s iodine starch test, Hyperhidrosis Disease Severity Scale (HDSS), and Dermatology Life Quality Index (DLQI) test. Results. At 3 weeks, a significant decrease in sweating for both preparations was noted which was more pronounced with Dysport compared with Botox. At 8 weeks, this difference turned insignificant. Continued evaluation showed similar improvement in both palms with a nonsignificant difference. Patients with longer disease duration were more liable to relapse. Conclusion. The efficacy and safety of Botox and Dysport injections were similar using a conversion factor of 1？:？2.5. There was a trend towards a more rapid action after Dysport treatment but without significant importance. 1. Introduction Palmar hyperhidrosis (PHH) is a condition characterized by excessive sweating of the palms. The condition causes significant disruption in both social and professional life, leading to a marked impact on the patient’s quality of life (QOL) [1]. Botulinum toxin is a potent neurotoxin which specifically inhibits the release of acetylcholine from nerve terminals by acting mainly on the cholinergic synapses [2]. It has been well studied in neurology as well as other disciplines, as focal hyperhidrosis, axillary, and PHH and is considered the treatment of choice in many of its indications [3]. Although the human nervous system is affected by all seven types (A–F), if applied parentally, type A preparations are most commonly used in clinical practice for various reasons such as their prior availability, immunologic aspects, safety, and efficacy [4]. Among the type A preparations, are Onabotulinum toxin A or Botox (Allergan, Inc., Irvine, CA) and Abobotulinum toxin A or Dysport (Ipsen Limited, Slough, Berkshire, UK) which are not bioequivalent [5]. Botox is purified by repeated precipitation and redissolution and is formulated with 500？mg human serum albumin with 0.9？mg sodium chloride. It contains less than
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