How does Botox work against hyperhidrosis?
Botulinum toxin has been used for many years to treat hyperhidrosis. The active ingredient reversibly blocks the signal transmission between nerves and sweat glands by inhibiting the release of the neurotransmitter acetylcholine. As a result, the sweat glands receive fewer signals for sweat production, and sweating in the treated areas can be significantly reduced.
In Germany, botulinum toxin A is approved for severe primary axillary hyperhidrosis when topical therapies are not sufficiently effective. Applications to other body areas such as hands or feet are considered off-label use.
Which body areas is Botox suitable for?
Botox is most commonly applied to the armpit area. There, the treatment is considered relatively straightforward and well-tolerated. The injections are administered in several small increments directly under the skin. Anesthesia is usually not required in the armpit area.
Hands and feet can also be treated. Since these areas are more sensitive, a local anesthetic cream is often applied beforehand. At the same time, side effects such as pain, itching, or temporary weakness of the hand muscles occur more frequently with palmar application.
What do studies show?
Several studies show that botulinum toxin can significantly reduce symptoms of hyperhidrosis and improve quality of life.
In a prospective before-and-after study with 81 patients suffering from axillary hyperhidrosis, both the severity of symptoms and quality of life significantly improved. The HDSS score decreased from 3.4 to 1.5, while the Dermatology Life Quality Index (DLQI) improved from 19 to 6.9 – even one year after treatment. The underlying study by Castiglione et al. specifically investigated the long-term efficacy of botulinum toxin for axillary hyperhidrosis1.
Positive results have also been reported for palmar hyperhidrosis. In a retrospective study with 30 patients, the HDSS score improved by at least one point in 93% of those treated. The effect lasted for a median of approximately four months after the first treatment. The study by Farrell et al. specifically analyzed the efficacy and duration of action of botulinum toxin A for severely sweating hands2.
How long does the effect last?
The effect of Botox usually lasts for several months. Ideally, the treatment needs to be repeated once or twice a year.
How long the effect lasts can vary individually and depends, among other things, on the treated body region and the severity of hyperhidrosis.
What side effects can occur?
When administered correctly, botulinum toxin is considered well-tolerated. In the armpit area, predominantly mild to moderate side effects are described. These include, for example, temporary redness or mild discomfort at the injection sites.
When applied to the hands or feet, additional local pain, itching, or temporarily reduced grip strength may occur. In the study on palmar hyperhidrosis, a temporary reduction in grip strength was observed in 23% of participants2. In one isolated case, temporary weakness of the hand muscles was observed.
When can Botox be beneficial?
Botox is a potential treatment option for hyperhidrosis, especially when conservative measures are not sufficiently effective. Before more invasive treatments are considered, topical antiperspirants, medicated creams, or procedures such as tap water iontophoresis are often used first.3.
The most suitable therapy for an individual case should always be decided in consultation with a doctor.
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