Can Botox treat hyperhidrosis?

Botox for hyperhidrosis of the underarms can be very effective and is one of the areas of the body where as little as 2 needle sticks can get rid of excessive sweating anywhere from 3 months to 6 months or more. Once the individual becomes tired of repeated injection, or in the rare situation where the effectiveness diminishes, then there are other good options to treat hyperhidrosis of the underarms such as dermatosuction or endoscopic thoracic sympathectomy (ETS, micro ETS).

www.EliminateSweating.com

Hratch L Karamanoukian, MD 

Botox is FDA approved and is very effective and safe treating excessive underarm sweating (hyperhidrosis). It is widely used for this indication.

The underarm region is pre-treated with a topical anesthetic. The treatment requires injecting a series of small volumes of Botox directly into the skin covering the anatomical area. The Botox effect lasts about 6 to 9 months.

Thanks for your question.

I would like to make a small correction: Botox is actually FDA approved to treat hyperhydrosis - excessive underarm sweating. In many cases, insurance will cover this procedure, therefore minimizing the cost to subscribers. Considering this, and how safe, simple and effective this procedure is, I think it is much preferable to having a thoracic (chest) surgical procedure.

I have been very happy with the results from using Botox to treat excess sweating in the axilla (underarms).  Most of my patients have experienced a significant decrease in sweating for 6 to 9 months.  The procedure is relatively painless and although it appears costly at first, think of all the clothing that you have damaged over the years due to excess sweating.

I have also treated a patient who developed localized sweating on the forehead and temples and scalp after chemotherapy treatments and she had excellent reduction in sweating for 6 months.

Consider it a safe option for hyperhidrosis!

Hyperhydrosis can be treated by Botox but it takes much more than for facial wrinkles and added up over years, you are looking at a very expensive proposition.

Endoscopic surgery in the chest can cut sympathetic nerves and help with the palm sweating permanently.

The social embarrassment associated with excessive sweating can be profound. Whether the problem is primarily underarm sweating or palmar sweating, or both, the impact on normal social interaction can be significant. Some individuals with excessive underarm sweat production wear special pads and garments to try to 'stem the tide'. Many with excessive palmar sweating avoid shaking hands at all costs.

For the first time there is safe, reliable and well-tolerated means of reducing sweat production that is quickly and easily administered and lasts for months: BOTOX ® injection. BOTOX ®, approved now for several years for the treatment of facial wrinkles, is now FDA-approved for the treatment of hyperhidrosis.

The chemical that is released by nerve endings to stimulate muscle contraction, acetylcholine, is the same chemical that causes sweat glands to produce sweat. BOTOX ® works, in both cases, by preventing the release of this chemical from nerve endings, thereby blocking muscle contraction (when injected in the area of facial muscles) and blocking excessive sweat production (when injected into the skin of the underarms or palms).

We are currently treating patients with excessive sweating of both the palms and the underarms. The treatment on average lasts about six months, which is somewhat more prolonged that the effect of BOTOX ® injection for facial wrinkles. To reduce the discomfort associated with multiple injections, the skin of the treated area is cooled with ice packs immediately prior to BOTOX ® administration. For injection of the palms, the treatment area can be numbed completely by the administration of a local anesthetic adjacent to the palmar sensory nerves.

Many of our patients come in for treatment on a regular basis, usually about twice a year, so that this frustrating problem is almost completely eliminated from their lives. Others come in advance of important social engagements, such as weddings and reunions, and before important public appearances. Our patients who have undergone BOTOX ® for hyperhidrosis often state that the treatment is life changing.

Botox is often used to downregulate the sweatglands. Sweating volumes get reduced because some of the nervous system modulation of sweating gets weakened.

This use of Botox is considered "Off-Label," which means that it is not sanctioned by the FDA, but it is also not forbidden. The reality is that the FDA, in evaluating a new drug or device, is unable to test every possible clinical situation that the new drug or device might be effect for. Unless it poses a clear danger, a new drug or device, if cleared for one or more uses, will often be found to have other untested uses. That being said, Botox works very well to reduce sweating in the palms and underarm areas.

Hyperhidrosis means excessive sweating, typically in the armpits. This is very effectively treated with tiny injections of Botox into the hair-bearing skin of the armpits.

Increasingly, women without true hyperhidrosis but with normal sweating are having their armpits treated with Botox injections. The Botox treatment in the armpit eliminates sweating, and for many women also eliminates the need for deodorants, slightly. The treatment only takes a few minutes. The results last nine months on average and the treatment in Manhattan costs approximately $1000.

Botox has been used to treat hyperhidrosis.  It is a very effective treatment for this condition. It is usually done in a grid like fashion. This is most commonly done for the armpits.

Botulinum Toxin (Botox (R)) is a very successful method of treating hyperhydrosis. It is generally given in a grid-like pattern in the area to be treated. The Botox (R) is given intradermally with a fine gauge needle, and is minimally painful. Hyperhydrosis is an FDA approved indication for Botox (R) where topical antiperspirants have failed

Botox is FDA approved to treat primary axillary (arm pit) hyperhidrosis. It was approved for this indication in July of 2004. The drug blocks the nerve function to the nerves that stimulate sweating.

When a practitioner performs this procedure, he or she normally dilutes it more than he or she would when treating wrinkles on the face. This allows more diffusion of the product in the area being treated.

Some practitioners sprinkle corn starch in the area prior to injecting, which turns purple-colored in the areas that are most actively producing sweat. We then can make sure to focus our injections in those locations before moving on to the rest of the area. 

Sweating in the treated areas is usually significantly reduced for up to 6 months. 

Off-label use for Botox treatment for hyperhidrosis includes injecting the palms and soles, which works great but is often quite uncomfortable to receive. 

Some insurance companies will pay for Botox injections under the arms when the physician/PA/NP documents treatment failure on other, less costly prescriptions (such as Dry-Sol, for example).

Botox is an amazing and effective treatment for hyperhidrosis (excessive perspiration). We utilize it most commonly for the axillae (underarms) but also use it for the palms, soles and for focal areas in which patients complain of sweating, such as the forehead.

It works by diminishing the sweat secretions of the eccrine glands. You must be sure that your dermatologist rules out any underlying metabolic disorder causing the excessive sweating, though those cases are uncommon.

It is a fast procedure, sometimes reimbursable by insurance companies, and can give relief from 7 to 17 months!!! It has changed many of my patients' quality of life, and I get only positive feedback.

Absolutely. Botox is an excellent treatment for under arm hyperhidrosis.

Excess under arm sweating can be diagnosed with a simple in office exam using iodine and starch powder. The area is then injected with Botox just below the surface of the skin, covering the entire area of staining. Typically 50 units are used in each under arm area. My patients experience a dramatic reduction in sweating and the treatments last about 6-7 months. There are no significant complications from the superficial injection of Botox.

Botox is sold as Botox and Botox Cosmetic. When there is a possibility of insurance reimbursing the treatment, which is rare, Botox must be used.

While Botox is very successful at treating axillary hyperhidrosis, it is temporary. A longer-lasting option that is also very effective is superficial liposuction of the axilla.

Recently, superficial subdermal treatment with the 1064  nm or 1320 nm laser has been shown great promise. These treatments help to eliminate the sweat glands that produce sweat in this area, and have been demonstrated to be very safe.

Botox, or botulinum toxin type A, was approved by the FDA in 2004 for the treatment of severe primary axillary hyperhidrosis (excessive underarm sweating) that is inadequately managed with topical agents. Botox can also be used for excess sweating in other areas, though this is technically an off-label use.

Currently, in the United States, botulinum toxin type A is marketed only by Allergan Corporation under the name Botox and Botox Cosmetic. Some insurance companies will reimburse the cost for Botox injections for hyperhidrosis. Though Botox and Botox Cosmetic are the same compound, if insurance reimbursement is being sought, it is imperative that Botox and not Botox Cosmetic be used.

For axillary hyperhidrosis, definition of the area to be injected is performed first. This can be done in several ways. Once the area is defined, the recommended starting dose is 50 units per axilla.

According to Allergan the most common side effects included injection site pain and hemorrhage, non-axillary sweating, infection, pharyngitis, flu syndrome, headache, fever, neck or back pain, pruritis, and anxiety.

Typcial results from Botox injections to the armpit area is a 50-80% reduction in sweat production. This is often the perfect amount since some sweat function in this area is essential as a normal process of your body. 

The armpit skin isn't that sensitive, and patients tolerate it very well, by evidence, that they always return for repeat injections.  If you don't get enough of a result, then your physician can increase the dose in 3 months for your next treatment

Botulinum toxin A injections have been used successfully to reduce excessive sweating in all of the body areas affected in hyperhidrosis:

• Axillary
• Palmoplantar
• Facial/gustatory

Characterized as a “minimally invasive treatment option” compared to local surgery and endoscopic thoracic nerve surgery, the use of botulinum toxin has become an important treatment option for patients not responding to more conservative therapies.

BOTOX's mechanism of action is certainly able to treat hyperhydrosis. 

The mechanism of BOTOX targets conduction of nerve endings to muscle cells as well as autonomic cholinergic nerve endings such as sweat glands within the skin.  This can be used to treat:

• Hyperhydrosis, or excessive sweating
• Normal sweating
• Pathologic sweating, such as Frey's syndrome, which occurs after salivary gland removal

Botox®, the commercially available form of Botulinum toxin type A, is a very effective, but temporary treatment for hyperhydrosis (sweaty palms, sweaty armpits, etc).  The reason for this is that the receptor that activates the sweat gland is very similar to the one that exists between motor nerves and muscles (in the forehead, crow's feet, and glabella). 

My personal experience is that Botox® lasts longer when used for this indication than it does for hyperdynamic facial lines, lasting up to 6 months.  The way Botox® is administered is via multiple shots with a very small needle to the skin of the affected area. 

My experience is that patients will generally require about 100 units (for both armpits) to achieve a result they are happy with. As with other indications for Botox®, the result takes 3-7 days to become obvious.

Botox works by inhibiting a neurotransmitter, Acetylcholine, from being released.  This happens to be the same neurotransmiiter used for moving muscles, and to produce sweat. 

It shouldn't be the first thing you try for excessive sweating, but if everything else fails, it's great for underarms, hands, and feet. 

Hands and feet are a little more painful and sometimes require blocks, but results are dramatic.  About 100 units of Botox are needed to do the underarms (total for both), and the same for both hands.

Hyperhydrosis, also known as excessive sweating, can range from mild to extreme. When hyperhidrosis is extreme, it is not just an annoying condition, it can be disabling.

The excessive sweating of the hands can make it difficult to work. When it affects the underarms, it can drench your clothes in sweat. When it affects the feet, it can lead to horrible fungal infections which make even walking difficult.

Treatment with Botox is FDA approved and very effective. Some insurance companies may even be willing to reimburse you for the cost of treatment.

If you intend to try to get reimbursement from your insurance company, be aware that there are a few hoops you need to jump through to have a chance at getting some money back.

• First, make sure the doctor uses a vial of Botox that is specifically labeled for therapeutic use. The therapeutic vials and the cosmetic vials both contain exactly 100 units of Botox, but the therapeutic vials have a different NDC number.

I have seen some insurance companies reject the claim because the wrong NDC  number was submitted. (In my opinion, that sort of rejection is completely unethical, but insurance companies are in the business of making money, not in the business of helping people).

• Second, make sure you have tried some other treatment, such as drysol applied to the affected area. Again, insurance companies may reject your claim unless you have tried and failed using some less expensive alternative before you try Botox.

Botox can be injected into axilla (underarms) with very little discomfort. I use a 33 guage needle, which makes it almost painless.

On the otherhand, Botox injections into the palms or soles is very painful. In order to inject these areas, I perform a nerve block. The nerve block is very effective, but it might make your hands or feet too numb to drive home, so make sure you have a driver to take you home after the treatment.

Michael Sinclair, MD

Botox is extremely effective for Hyperhidrosis.  According to a study published in The Journal of Drugs and Dermatology this year that compared Aluminum Chloride deodorants (Drysol) to Botox, patients had 92% satisfaction with Botox vs. only 29% with the Aluminum Chloride deodorant after 4 weeks. 

Injections done by a qualified practictioner cause minimal discomfort and effects normally last about 6 months.