DERMATOLOGIC SURGERY The comparative effectiveness of suction-curettage and onabotulinumtoxin-A injections for the treatment of primary focal axillary hyperhidrosis: A randomized control trial Omer Ibrahim, MD, a,d,e Rohit Kakar, MD, a Diana Bolotin, MD, PhD, a Michael Nodzenski, BA, a Wareeporn Disphanurat, MD, a Natalie Pace, BS, a Lauren Becker, MD, a Dennis P. West, PhD, a Emily Poon, PhD, a Emir Veledar, PhD, f and Murad Alam, MD, MSCI a,b,c Chicago, Illinois; New Haven, Connecticut; and Atlanta, Georgia 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. ( J Am Acad Dermatol 2013;69:88-95.) Key words: axillary hyperhidrosis; botulinum; gravimetry; onabotulinum; suction; suction-curettage; underarm sweating. P rimary hyperhidrosis is a common disorder affecting 2.8% of the US population. 1 Although not life threatening, hyperhidrosis has been shown to have a significant negative quality-of-life impact. 2 Fortunately, some forms of primary hyperhidrosis, such as primary focal From the Departments of Dermatology, a OtolaryngologyeHead and Neck Surgery, b and Surgery, c Northwestern University, Chicago; Department of Dermatology, Yale University School of Medicine, New Haven d ; Department of Dermatology, Cleveland Clinic Foundation, Cleveland e ; and Department of Medicine, Emory University School of Medicine, Atlanta. f Funded by the Department of Dermatology, Northwestern Uni- versity. No funding or product was received from Allergan (manufacturer of Botox). Disclosure: Drs Alam and West have been investigators for other studies with Allergan (Botox), but no compensation was received by them from these earlier, unrelated studies. Drs Ibrahim, Kakar, Bolotin, Disphanurat, Becker, Poon, and Veledar; Mr Nodzenski; and Ms Pace have no conflicts of interest to declare. Accepted for publication February 21, 2013. Reprint requests: Murad Alam, MD, MSCI, Department of Dermatology, Northwestern University, 676 N St Clair St, Suite 1600, Chicago, IL 60611. E-mail: m-alam@northwestern.edu. Published online April 15, 2013. 0190-9622/$36.00 Ó 2013 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2013.02.013 88