GLASS LAB · Medical Aesthetics Evidence Index 303 cells · 19,226 papers · 5,969 top-tier evidence

Hyperhidrosis · Palmar hyperhidrosis

Botulinum toxin a evidence for Palmar hyperhidrosis

B 57.9 / 100 Supported 69 RCT/meta · 88 clinical/observational · 152 case · 401 total
Good evidence · positive conclusion

There is a relatively good level of clinical evidence, and a majority of papers support its effectiveness.

Grade combines the quantity and quality of the research, while direction is a separate signal showing how the papers assess effectiveness.

Includes meta-analysis/SR Median year 2009 Last 5 years 14% Positive results 50% Negative results 17 Korea/Asia 6

Known in Korea as

톡신보톡스제오민디스포트코어톡스주름 보톡스다한증 보톡스디자인 보톡스사각턱 보톡스얼굴전체 톡신

Procedure and brand names vary, but the evidence above applies to the same procedure mechanism.

Key papers

tier1 Botulinum Toxin Type A in the Treatment of Primary Axillary Hyperhidrosis:A Phase 3, Multicenter, Randomized, Double-Blind, Placebo-Controlled Study of Efficacy and Safety in Chinese Patients. Aesthetic surgery journal · 2026 · PMID 41553927

Abstract summary (English) BACKGROUND: The efficacy and safety of botulinum toxin type A (BoNTA) treatment for primary axillary hyperhidrosis (PAH) have not been explored in the Chinese population. OBJECTIVES: The objective was to evaluate efficacy and safety of 1 intradermal BoNTA injection in Chinese PAH cases. METHODS: This was a Phase 3, multicenter, randomized, double-blind, placebo-controlled study.

Journal Article, Randomized Controlled Trial, Multicenter Study, Clinical Trial, Phase III

View on PubMed
tier1 Beyond the axilla: The evolving role of botulinum toxin in the treatment of facial, scalp, and focal hyperhidrosis. Clinics in dermatology · 2025 · PMID 41461243

Abstract summary (English) Botulinum toxin type A is an established treatment for focal hyperhidrosis of the axillae and palms, but its use has recently expanded to include craniofacial, facial, and scalp hyperhidrosis. This systematic review with narrative synthesis evaluates the clinical use of botulinum toxin type A for focal hyperhidrosis across multiple anatomic sites. A structured search of PubMed/MEDLINE, Embase, and Scopus was...

Journal Article, Systematic Review

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tier1 A Comparative Study of Aluminum Chloride, Oxybutynin Chloride, and Botulinum Toxin in the Treatment of Primary Focal Hyperhidrosis. Journal of cutaneous medicine and surgery · 2025 · PMID 40396355

Abstract summary (English) BACKGROUND: Primary hyperhidrosis (HH) is a common challenging problem. Different treatment modalities are present with no clear evidence favoring one modality over the others. OBJECTIVES: To assess and compare the efficacy of aluminum chloride hexahydrate (ACH), oxybutynin chloride, and botulinum toxin type-A (BTX-A) in treating primary focal HH.

Journal Article, Randomized Controlled Trial, Comparative Study

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tier1 Efficacy and Safety of Botulinum Toxin Type A in Primary Axillary Hyperhidrosis: A Meta-analysis and Systematic Review. Aesthetic plastic surgery · 2025 · PMID 40500510

Abstract summary (English) BACKGROUND: The clinical efficacy of botulinum toxin type A (BTX-A) injections for the treatment in primary axillary hyperhidrosis is a subject of ongoing debate. This study aims to consolidate and analyze the available evidence regarding the use of BTX-A as a therapeutic intervention for this conclusion. METHOD: This study was conducted in accordance with PRISMA guidelines and registered with PROSPERO.

Journal Article, Systematic Review, Meta-Analysis

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tier1 The comparative study of letibotulinum toxin A and onabotulinum toxin A in treatment of primary axillary hyperhidrosis. Archives of dermatological research · 2025 · PMID 40167830

Abstract summary (English) Primary axillary hyperhidrosis (PAH) is a challenging condition characterized by excessive underarm sweating. The U.S. Food and Drug Administration has approved onabotulinum toxin A (OnaBTX-A, Botox®, Allergan Inc, USA) as the only botulinum toxin treatment for severe axillary hyperhidrosis, and it has demonstrated positive results.

Journal Article, Comparative Study, Randomized Controlled Trial

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tier1 Tolerability and efficacy of botulinum toxin injection in the treatment of bromhidrosis: a systematic review and meta-analysis of clinical trials. Acta dermatovenerologica Alpina, Pannonica, et Adriatica · 2024 · PMID 39707893

Abstract summary (English) This review evaluates the risks and benefits of botulinum toxin (BTX) therapy for treating bromhidrosis. A search was conducted across six databases, including clinical trials comparing BTX therapy with BTX-free controls. The analyzed outcomes included pooled adverse events (AEs), treatment success, ≥ 50% overall improvement, and recurrence rates.

Journal Article, Meta-Analysis, Systematic Review

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tier1 Long-term efficacy of fractional microneedle radiofrequency versus botulinum toxin-A in primary axillary hyperhidrosis: a randomized controlled trial. Lasers in medical science · 2024 · PMID 38981914

Abstract summary (English) Primary axillary hyperhidrosis is an idiopathic disorder that creates severe psycho-social burden due to excessive uncontrolled sweating. Various therapeutic agents have been described, but each has its own limitations. The use of fractional microneedling radiofrequency has emerged lately with promising results.

Journal Article, Randomized Controlled Trial, Comparative Study

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tier1 Subclinical effects of botulinum toxin A and microwave thermolysis for axillary hyperhidrosis: A descriptive study with line-field confocal optical coherence tomography and histology. Experimental dermatology · 2024 · PMID 38884423

Abstract summary (English) Botulinum toxin A (BTX) and microwave thermolysis (MWT) are standard axillary hyperhidrosis treatments, but comparison of their subclinical effects is lacking. Line-field confocal optical coherence tomography (LC-OCT) is a promising non-invasive imaging tool for visualizing tissue-interactions. This study aimed to describe subclinical effects of BTX and MWT for axillary hyperhidrosis with LC-OCT-imaging compared to...

Journal Article, Randomized Controlled Trial

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tier1 Pain Control during the Treatment of Primary Palmar Hyperhidrosis with Botulinum Toxin A by a Topical Application of Liposomal Lidocaine: Clinical Effectiveness. Toxins · 2024 · PMID 38251244

Abstract summary (English) Primary palmar hyperhidrosis (PPH) constitutes a debilitating condition that profoundly impacts the social, functional, and occupational aspects of individuals. The intradermal administration of botulinum toxin type A (BoNT-A) stands as an established therapeutic approach for PPH, albeit one frequently accompanied by considerable pain, posing challenges for patient tolerance. Our study aimed to assess the efficacy...

Randomized Controlled Trial, Journal Article

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tier1 Botulinum Toxin Treatment for Cancer-Related Disorders: A Systematic Review. Toxins · 2023 · PMID 38133193

Abstract summary (English) This systematic review investigates the effect of botulinum neurotoxin (BoNT) therapy on cancer-related disorders. A major bulk of the literature is focused on BoNT's effect on pain at the site of surgery or radiation. All 13 published studies on this issue indicated reduction or cessation of pain at these sites after local injection of BoNTs.

Systematic Review, Journal Article

View on PubMed

Suggested interpretation

Strong evidence base

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