Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies


Objective: The objective of this selective EBM review is to determine whether or not “Does onabotulinumtoxin type A reduce interference of daily activities for adults with hyperhidrosis?”

Study Design: A systematic review of three randomized control trials (RCTs) published after 2009 in peer-reviewed journals in the English language. These RCTs compared the efficacy of onabotulinumtoxin type A (BTX-A) to other treatment modalities in reducing the interference of daily activities for adults with hyperhidrosis.

Data Sources: Three RCTs were selected after searching the databases Pubmed, CINAHL plus, International Pharmaceutical Abstracts, and Central Register of Controlled Trials. Inclusion criteria was relevant studies published after 2009. Exclusion criteria was patients under 18 years old, too few subjects used in trial, and if the article was a systematic review or meta-analysis.

Outcomes Measured: The outcome measured was a reduction in interference of daily activities from hyperhidrosis. This was assessed via the hyperhidrosis disease severity scale (HDSS), a four-point subjective scale with a score of one correlating to no daily activity interference from sweating and a score of four correlating to constant interference.

Results: In the RCT conducted by Ibrahim et al., the mean HDSS scores were reduced by 1.55 points 3 months after the administration of onabotulinumtoxin type A (P<.001). In the RCT conducted by Campanati et al., every patient had a 2-point reduction in HDSS scores from baseline compared to 4 weeks after intervention with BTX-A, a statistically significant reduction (P<.001). The RCT conducted by Lueangarun et al., resulted in a reduction of 1.35 points on the HDSS scale four weeks after BTX-A cream application compared to baseline; when compared to the reduction of the control group this was statistically significant (P<.001).

Conclusion: All three RCTs found a reduction in daily activity interference due to hyperhidrosis with the implementation of onabotulinumtoxin type A. Although there were limitations to the studies, these findings suggest that onabotulinumtoxin type A is effective in reducing activity interference for those with primary hyperhidrosis.