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Management of Craniofacial Hyperhidrosis with Botulinum Toxin: A Systematic Review
Aikaterini Tsiogka1, Dimitra Peponi1, Elisavet Tsiogka1
11st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece.
Introduction:
Treatment of craniofacial hyperhidrosis (CFH) is challenging because of the anatomical characteristics of the head and face. Although topical anticholinergics are generally considered first-line therapy, botulinum toxin has emerged as an effective option, while evidence remains more limited than for axillary hyperhidrosis. The objective of this study is to systematically review current evidence on the efficacy and safety of botulinum toxin in the treatment of CFH.
Methods:
Clinical studies evaluating different types of botulinum toxin type A (BoNT-A) and type B (BoNT-B) for CFH were reviewed, focusing on treatment efficacy, onset of response, anatomical sites and safety.
Results:
BoNT-A was the most consistently studied formulation and demonstrated substantial improvement of CFH. The duration of response generally ranged from 4 to 9 months, with more recent cohorts reporting efficacy lasting up to 12 months. Onset of action typically occurred within 1-2 weeks. The forehead and scalp were the most frequently treated sites, followed by gustatory and occipital regions. BoNT-B also produced significant reductions in sweating and improvements in quality of life.
Conclusion:
Botulinum toxin appears to be an effective and safe treatment for CFH. Long-term studies are needed to establish the optimal toxin type, administration technique and retreatment interval.