The comparative effectiveness of suction-curettage and onabotulinumtoxin-A injections for the treatment of primary focal axillary hyperhidrosis: a randomized control trial

J Am Acad Dermatol. 2013 Jul;69(1):88-95. doi: 10.1016/j.jaad.2013.02.013. Epub 2013 Apr 13.


Background: Botulinum toxin injections and suction-curettage have been separately shown to be effective in treating axillary hyperhidrosis but have not been compared in the same patients.

Objective: We sought to compare effectiveness of suction-curettage versus neurotoxin for the treatment of axillary hyperhidrosis.

Methods: Each of 20 patients was randomized to receive toxin injections to one axilla and suction-curettage to the contralateral axilla. The primary outcome measure was reduction of sweat rate measured by gravimetry, and the secondary measure was quality of life as measured by a patient-directed questionnaire.

Results: At 3 months posttreatment, toxin injections decreased baseline resting sweat production by 72.1% versus 60.4% (P = .29) for suction-curettage, and baseline exercise-induced sweat production by 73.8% versus 58.8% (P = .10). When patients were stratified into the categories of light and heavy sweaters, there was a difference among heavy sweaters, with exercise-induced sweat production lower by 10.48 mg/min or 34.3% (P = .0025) at toxin-treated sites. Compared with suction-curettage, toxin also resulted in greater improvements in quality of life by 0.80 points (P = .0002) and 0.90 points (P = .0017) at 3 and 6 months posttreatment, respectively, as measured by the patient questionnaire.

Limitations: The follow-up period was limited to 6 months.

Conclusions: By objective measures 3 months after treatment, neurotoxin injections are nominally more effective than suction-curettage in all cases, and markedly more effective in heavy sweaters. Patients have a very significant preference for neurotoxin injections at 3 months, and this is maintained at 6 months.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Axilla
  • Botulinum Toxins, Type A / administration & dosage*
  • Comparative Effectiveness Research
  • Female
  • Humans
  • Hyperhidrosis / drug therapy*
  • Hyperhidrosis / surgery*
  • Male
  • Middle Aged
  • Neuromuscular Agents / administration & dosage*
  • Severity of Illness Index
  • Treatment Outcome
  • Vacuum Curettage*
  • Young Adult


  • Neuromuscular Agents
  • Botulinum Toxins, Type A