Botulinum for the treatment of excessive perspiration (hyperhidrosis)
Armpit sweat, wet hands and feet: Treatment with botulinum (or better known as Botox®) relieves the symptoms of hyperhidrosis. By this we mean excessive perspiration on the palms of the hands, on the soles of the feet or in the armpits.
How should a patient with hyperhidrosis proceed?
Most patients with hyperhidrosis have been suffering for a long time from perspiration in these particular areas, sometimes accentuated by emotional stress. In some patients, elevated thyroid hormones can be found. However, in most patients, no particular reason can be discovered, but gustatory perspiration is caused by the consumption of spicy food.
It is important to differ hyperhidrosis from nocturnal perspiration, which usually affects the whole body. If perspiration is a symptom you should consult your GP. An examination is important if you have fever, if you lose weight, if you cannot tolerate a warm environment, if you have diarrhea or cardiovascular symptoms, or if you take regular medication.
What treatments are available?
If the hyperhidrosis is not too excessive, deodorants and powders may help. Another option is iontophoresis. The hands or feet are placed in a shallow water bath, while a weak electric current flows through them. The patient feels only a subtle tingling sensation. The exact mechanism of this procedure on the sweat glands is unknown. After two weeks, the perspiration may decrease. However, the treatment has to be continued about every other day.
If these options are not successful or too time-consuming, botulinum (used product: BOCOUTURE®) is still worth a consideration. The medication is injected into the superficial layers of the skin and begins to take effect after one week. The success rate is high and the effects lasts from 3 to 6 months.
Why does botulinum help with hyperhidrosis?
Botulinum reduces the activity of the sweat glands. At the same time, it also reduces muscle activity. This is a desirable effect in cosmetic medicine, e.g. in the treatment of forehead lines. On the hands, this is an undesirable side effect. The maximum amount of botulinum that may be used against hyperhidrosis is therefore limited. According to clinical experience, botulinum can achieve sufficient control over sweat glands before side effects become relevant. The application of botulinum in the armpits or the foot area is easier: There is enough subcutaneous fat tissue between the skin and the muscles, so that botulinum cannot reach the deeper layers and cause side effects.
Is the botulinum treatment painful?
A botulinum treatment in the armpits causes only minimal pain. For most patients, it is sufficient to apply an ice pack before injection. If you are very sensitive to pain, an anaesthetic cream can be applied 15 minutes before injection.
The palms and the soles of the feet are more sensitive and injections without anaesthesia produce considerable discomfort and therefore, local anaesthesia is recommended for these areas. For the treatment of the palms, the anaesthetic is injected into the lower arm, so that the palms are insensitive to injections. For the treatment to the sole of the foot, an anaesthetic is injected next to a nerve near the ankle. This anaesthesia lasts for around 30 minutes.
Important: I must be informed of any allergies to local anaesthetics or if you suffer from heart disease.
Note: Health insurance rarely assume the cost for this treatment, which is normally at the patient’s expense.