Botulinum A toxin for Hyperhidrosis (Excessive sweating)

Hyperhidrosis (excessive sweating) describes sweating in excess of normal body temperature regulation. As a result, it can be classified by location (focal or generalized) and by the presence of an underlying cause (primary or secondary).

Primary focal hyperhidrosis has no underlying cause. Therefore it is also known as primary idiopathic, primary localized, or focal hyperhidrosis.

It most commonly affects the axillae, additionally may also involve the palms, soles, face, scalp, and groin.

By contrast, Secondary focal hyperhidrosis involves specific areas of the body, caused by an underlying condition.

Generalized hyperhidrosis affects the entire skin surface area and it usually has an underlying cause.

NHS leaflet for hyperhidrosis

Hyperhidrosis (excessive sweating) can be treated using Botulinum A toxin

Botulinum toxin is delivered by multiple intradermal injections to the affected areas.

It acts by inhibiting acetylcholine release from the sympathetic cholinergic nerve terminals that innervate sweat glands.

Botulinum toxin is licensed for the treatment of axillary hyperhidrosis (underarms)and may also be used for palmar (palms of hands) and plantar (soles of feet)

The effect may last for 6–9 months.

Adverse effects include pain during injections and compensatory sweating. Transient muscle weakness and loss of fine motor control have also been reported.

The treatment is effective at reducing sweating for most people with axillary hyperhidrosis.

The effects of the Botox® should be evident within five to ten days after the treatment, however 5-10% (between 1 in 20 and 1 in 10) of patients report no improvement.

Treatment results are expected to last four to six months.

When the Botox® wears off, your condition will return to its previous state – it will not worsen and there is no permanent effect.

All treatments have risks and side effects but not everyone will experience them. Usually side effects occur in the first few days after treatment and will disappear within a few days. Common side effects include: 

• Temporary pain where the injections have been given. 
• Some bumps appearing where the injections have been given. These will disappear within a few hours. 
• Bruising, swelling and/or redness at the site of the injections. 
• Some people experience flu-like symptoms or experience a tiredness or heaviness in the arms which usually resolves within a few days. 
• There is a small risk of a skin infection.

You should not receive treatment with Botox® if: 

• You have had an allergic reaction to botulinum toxin type A in the past. 
• You have an infection in or around any of the areas to be injected. 
• You have a febrile illness (a fever). 
• You are pregnant or breastfeeding. 
• You are a Jehovah’s Witness. 
• You have a medical condition that may interfere with neuromuscular function, such as myasthenia gravis, Eaton-Lambert syndrome or amyotrophic lateral sclerosis.

You should keep the area clean and try not to rub the injection sites for the first 24 hours as this may affect how well the treatment works. Avoid any exposure to extreme heat and avoid any exercise for 48 hours after the treatment.

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