Botox for Hyperhidrosis (Excessive Sweating)
HOW DOES BOTOX DECREASE SWEATING?
Botox became FDA-approved in 2004 for the treatment of severe primary axillary hyperhidrosis, meaning excessive sweating of the underarms. It can also be used for excessive sweating of the hands, feet, and face/scalp. Botox is a natural, purified protein with the ability to temporarily block the secretion of the chemical that is responsible for “turning on” the body’s sweat glands. By blocking, or interrupting, this chemical messenger, Botox “turns off” sweating at the area where it has been injected. Botox injections are very shallow, meaning that the medicine is injected just below the surface of the skin, where it remains.
Treating excessive sweating of the armpits, hands, feet, head and face (craniofacial), and other relatively small body areas (like under the breasts) with Botox is safe and effective. When used to treat underarm excessive sweating, Botox has been shown to result in an 82-87% decrease in sweating. Results start to be noticeable approximately 2 to 4 days after treatment with the full effects usually noted within 2 weeks. Dryness typically lasts about 6 months, but some studies have found it can last as long as 14 months. Additional statistics from published research studies have shown that repeated treatment with Botox is safe and effective for hyperhidrosis and consistently results in meaningful, long-lasting improvements in an excessive sweating patient’s symptoms, daily functioning, and quality of life. While sweating is an essential body function for temperature-control, localized body areas house only a small percentage of the body’s sweat glands (the underarms, for instance, are home to less than 2% of the body’s sweat glands.) The temporary cessation of these sweat glands’ functioning, therefore, has little to do with body thermoregulation.
In the case of palmar (hand) excessive sweating, research shows that Botox is 80-90% effective. Repeat injections are needed after 6 months. Botox for palmar sweating may cause temporary pain and weakness in the hands.
Botox injections work well on the head and face, but the injection technique requires skill, so patients should seek a board-certified Dermatologist. A potential side effect of Botox injections in the face as a treatment for sweating is asymmetry, particularly of the forehead. This can happen if some of the Botox diffuses into the facial muscles. Such asymmetry, however, is always temporary and can, if necessary, be balanced-out by additional Botox injections.
HOW IS THE PROCEDURE PERFORMED?
Injections can be administered in a physician’s office, require relatively little time (our board-certified Dermatologists at Castle Dermatology can inject both underarms in less than 10 minutes), and do not demand any restrictions in work or leisure activity (aside from refraining from intensive exercise or the use of a sauna on the day of the injections). Prior to Botox injections in the underarms, it’s best not to shave that area. Many physicians, in fact, prefer three to four days of hair growth prior to Botox injections.
Prior to the procedure, numbing cream or ice can be applied to the skin. During the procedure, a very fine needle is used to inject tiny amounts of Botox just under the skin intermittently throughout the area of excessive sweating (in a grid pattern, approximately every 1 to 2 centimeters.) Multiple injections are given based on your doctor’s assessment of the area that needs to be treated.
After you receive Botox injections for any focal area, it’s recommended that you follow-up with your healthcare provider in 1 to 2 weeks. This follow-up is highly useful because it enables your physician to ‘touch-up’ any sweating areas that may have been missed during the first round of injections and ensure that you are getting the treatment’s full benefit.