We read with interest the article by Karamfilov et al1suggesting lower relapse rates of hyperhidrosis after high-dose botulinumtoxin type A injections (BOTOX; Allergan Inc, Irvine, Calif; hereinafter,generically, botulinum toxin A).1 Variousprotocols for treating hyperhidrosis with botulinum toxin A have been issuedempirically without controlled comparison of doses, dilutions, number of injections,or pharmaceutical products. Thus, any attempt to provide evidence-based informationon how to optimize botulinum toxin A treatment should be welcomed. For thispurpose, however, stringent study designs, accurate measurements of sweating,and uniform follow-up schedules are indispensable. Unfortunately, Karamfilovet al1 did not implement a control groupreceiving low-dose botulinum toxin A, which could have been easily providedby a left-vs-right comparison, with each patient being his own control.
Heckmann M, Schaller M, Breit S, Plewig G. Evaluation of Therapeutic Success of Hyperhidrosis Therapy. Arch Dermatol. 2001;137(1):94. doi: