Botulinum for the treatment of excessive perspiration

Underarm sweat, wet palms and feet: Treatment with botulinum (or more commonly known as Botox®) alleviates the symptoms of hyperhidrosis. This is the term we use to describe excessive sweating on the palms of the hands, the soles of the feet or in the armpits.

What should a person with hyperhidrosis do?

Most patients with hyperhidrosis have been suffering from excessive sweating, sweaty hands, foot sweat, etc. for a long time. sometimes intensified in emotionally stressful situations. In some people, an examination of the thyroid hormones is useful, but usually no cause can be found. Only in the case of gustatory sweating is the cause known, namely the consumption of spicy food.

It is important to distinguish sweating on these parts of the body from night sweats, which usually occur all over the body. If you have only been sweating unusually for a few weeks or months and other symptoms are added, you should consult your family doctor. Clarification is important if you have a fever, lose weight, cannot stand a warm environment, have diarrhoea or circulatory problems, or regularly take medication.

What treatments are available for excessive sweating?

If the sweating is not too pronounced, deodorants and powders can help. Another therapy option is iontophoresis. Here we expose the hands or feet to a weak current in a shallow water bath. In the armpits, we use moist compresses through which a weak current flows. The patient only feels a slight tingling sensation. The exact effect of this method is unknown, but if the treatment is successful, sweating is reduced after about two weeks. However, iontophoresis must be continued afterwards.

If deodorants or iontophoresis do not bring success, the use of botulinum (popularly known as Botox®) still offers great chances of success. We inject the drug superficially into the skin, where it takes effect after one week. The average duration of effect is 3 to 6 months.

Why does botulinum also work for sweating?

Botulinum inhibits the activation of the sweat glands by the nervous system. In the same way, it also slows down the activation of the muscles, which is the desired effect in cosmetic medicine, e.g. for the treatment of forehead wrinkles. On the hands or feet, however, this is an undesirable effect. This limits the maximum amount we can inject against sweating. Experience has shown that we can achieve good control of sweating in most patients before side effects occur in the form of reduced strength in the hands. The application of botulinum in the armpits or on the soles of the feet, on the other hand, is easier: in the armpits and on the soles of the feet, the skin (including fatty tissue in the subcutis) is thick enough so that there is a large distance to the muscles or the nerve fibres. Therefore, you do not have to fear a decrease in strength in the arms or the foot muscles.

Is the injection of botulinum painful?

In the armpits, the treatment is hardly painful. For most patients, it is enough to apply an ice-cold gel pack briefly and then do the injection immediately afterwards. If you are very sensitive to pain, I apply an anaesthetic cream 15 minutes before the treatment. The palms of the hands and feet are more sensitive, so ice spray provides the anaesthetic.

Important: Be sure to let us know if you suffer from allergies to anaesthetic medication or heart disease!

It should be mentioned that health insurance companies very rarely cover the cost of treatment and therefore it is at the patient’s expense.