Treatment Of Excessive Sweating (Hyperhidrosis) With Botulinum Toxin

Excessive sweating, or hyperhidrosis, is a significant problem for many people. Hyperhidrosis is often associated with an unpleasant odour. This is because when sweat remains on the skin for prolonged periods, it forms a breeding ground for bacteria. Botulinum toxin is an accepted and effective method for treating hyperhidrosis. It is generally used to treat excessive sweating in the armpits (axillary hyperhidrosis). Botulinum toxin is a bacterial protein that works by blocking transmission between the nerve and the sweat gland. Other functions of the nerve, such as sensation, are not affected.

What to expect during treatment

During treatment, some patients experience mild to moderate discomfort. In most cases, however, no local anaesthetic is required. If desired, a topical anaesthetic gel may be applied before the procedure. Using a very fine needle, small amounts of botulinum toxin are then injected into the skin. Several small injections will be required to cover the area of concern. Immediately after treatment, the area may be red and you may experience mild swelling. These will settle within a few hours. Occasionally bruising may occur. Like normal bruising, this will take 10 - 14 days to settle.

Potential contraindications to treatment

Whilst botulinum toxin is not associated with any serious complications, treatment is best avoided if you fall into one of the categories listed below:

  • Pregnant and / or breastfeeding
  • Patients with generalised neurological or muscular disease e.g. multiple sclerosis, myasthenia gravis, Bell’s palsy, Eaton Lambert syndrome
  • Patients taking aminoglycoside antibiotics e.g. erythromycin
  • Patients taking other drugs including penicillamine; quinine; calcium channel blockers; non-steroidal anti-inflammatory drugs (NSAIDS). Ideally, these drugs should be discontinued one week before treatment
  • Patients with bleeding disorders e.g. haemophilia or taking warfarin

In addition, patients taking supplements such as Vitamin E, ginkgo biloba and St. John’s Wort are more likely to experience bruising. These supplements should therefore also be discontinued one week prior to treatment.

Aftercare advice

You will be provided with a detailed aftercare information sheet. However, some of the important things to avoid are listed below:

  • Avoid lying down for 4 hours
  • Avoid exercising / gym for 24 hours
  • Avoid massaging the areas for 48 hours

How long will it last?

The effects of Botulinum toxin take around 3 days to establish, although this may vary. The peak effect of the toxin occurs 1 to 2 weeks after injection. The effects of the toxin are however temporary, lasting for between 3 to 6 months.

Rarely, the treatment may have no effect whatsoever, even after repeated injections. Unfortunately, this is impossible to predict before treatment is given.