A Comparative Study of Aluminum Chloride, Oxybutynin Chloride, and Botulinum Toxin in the Treatment of Primary Focal Hyperhidrosis

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. Patients and Methods: Sixty-six patients of both sexes, with primary HH, were equally and randomly divided into 3 groups. Group (A) received a single session of intradermal (BTX-A), Group (B) received topical application of ACH lotion 25% once daily, and Group (C) received oral oxybutynin chloride 10 mg daily for 3 months. The clinical response was assessed using the Hyperhidrosis Severity Scale (HDSS) and the patients were followed up for 6 months. Results: The 3 modalities were effective and safe in the treatment of primary HH, but the clinical response was significantly higher in the BTX-A group (81.8% excellent response) compared to the other 2 modalities. The reduction of hyperhidrosis was also maintained for a longer period in the BTX-A group. Conclusion: Among the 3 modalities, BTX-A was associated with a higher reduction of HDSS scores. A single session was sufficient; however, pain and high cost are limiting factors.