Botulinum Toxin for Hyperhidrosis
What Is Hyperhidrosis?
Hyperhidrosis is a condition defined as excessive sweating, usually in localized areas such as the palms of the hands, soles of the feat, and/or axillae. However, in some people, this excessive sweating can occur all over the body including the back, chest, abdomen, legs, and scalp. When sweating is the only issue, this is known as primary hyperhidrosis and is not typically associated with any other illnesses. However, some people may have the sweating as part of another illness or genetic condition. In this case, the excessive sweating is known as secondary hyperhidrosis.
For some people that have hyperhidrosis, the social impact can be devastating as it can lead to constant armpit sweat stains, embarrassment, and an inability to wear certain clothing like heels or sandals that can slip off the feet easily. For people who continue to have excessive sweating despite topical antiperspirant use, botulinum toxin A injections may be an effective treatment modality for both the physical condition and also to improve quality of life.[3,4]
What Is Botulinum Toxin?
Botulinum toxin type A is approved by the United States Food and Drug Administration (FDA) to treat axillary hyperhidrosis. It is also used off-label to manage hyperhidrosis in other body areas. Although there are several brands of botulinum toxin A, the US FDA has only approved Botox (onabotulinumtoxinA) for severe axillary hyperhidrosis that is not responding to other topical treatments in adults.
Brand names associated with Botulinum Toxin A include Botox, Dysport, and Xeomin.
How Does Botulinum Toxin for Hyperhidrosis Work?
Normally, the eccrine sweat glands (responsible for most of the sweating that occurs) are controlled by nerves that link up to the sweat glands. The nerves stimulate the sweat glands to start sweating by releasing a chemical known as acetylcholine. Botulinum toxin A works for hyperhidrosis by blocking the release of acetylcholine from the nerves so that it is no longer able to communicate to the sweat glands well.
What Conditions Does Botulinum Toxin Treat?
Botulinum Toxin A – FDA Approved Treatments*
Axillary hyperhidrosis (Botox)
Facial lines/wrinkles (Botox, Dysport, Xeomin)
Urinary incontinence in people with overactive bladders (Botox)
Chronic migraines (Botox)
Muscle stiffness (Botox, Dysport, Xeomin)
Blepharospasm (Botox, Xeomin if already treated with Botox)
*Brand names in parentheses
How Is the Medication Given?
Botulinum toxin A is given by injections into the affected skin sites, typically every 4-6 months.
What Are the Common Side Effects and Risks of Botulinum Toxin for Hyperhidrosis?
The most common side effects of botulinum toxin A treatment for hyperhidrosis include pain and bleeding at the injection site along with increased sweating in other areas out of the injection sites.
Botulinum toxin A injections can be painful, and it may be helpful to reduce the size of the needles used during the injections. Some health practitioners may use a numbing cream or cold air to reduce the pain with the injections.
Please consult the drug package insert for complete prescribing information and for complete information regarding side effects.
- Hornberger J, Grimes K, Naumann M, et al. Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol.2004;51(2):274-286; PMID: 15280848.
- Hamm H. Impact of hyperhidrosis on quality of life and its assessment. Dermatol Clin.2014;32(4):467-476; PMID: 25152339.
- Campanati A, Penna L, Guzzo T, et al. Quality-of-life assessment in patients with hyperhidrosis before and after treatment with botulinum toxin: results of an open-label study. Clin Ther.2003;25(1):298-308; PMID: 12637128.
- Swartling C, Naver H, Lindberg M. Botulinum A toxin improves life quality in severe primary focal hyperhidrosis. Eur J Neurol.2001;8(3):247-252; PMID: 11328333.
- Allergan. Highlights of prescribing information: BOTOX. In: Ireland AP, ed: Food and Drug Administration; 2011.
- Link to research. Accessed December 27, 2016.
- Bushara KO, Park DM, Jones JC, et al. Botulinum toxin--a possible new treatment for axillary hyperhidrosis. Clin Exp Dermatol.1996;21(4):276-278; PMID: 8959898.
- Alam M, Geisler A, Sadhwani D, et al. Effect of Needle Size on Pain Perception in Patients Treated With Botulinum Toxin Type A Injections: A Randomized Clinical Trial. JAMA Dermatol.2015;151(11):1194-1199; PMID: 26352252.
- Patel R, Halem M, Zaiac M. The combined use of forced cold air and topical anesthetic cream for analgesia during the treatment of palmar hyperhidrosis with botulinum toxin injections. J Drugs Dermatol.2009;8(10):948-951; PMID: 19852126.