Hyperhidrosis Treatment with Botox or Xeomin

Botulinum toxin type A is a safe and effective method for treating focal hyperhidrosis, providing longer-lasting results than topical treatments without the necessity of invasive surgical procedures. Although more useful for axillary hyperhidrosis, botulinum toxin injections can also be effective in treating palmar and plantar disease. The effects of botulinum toxin last for six to nine months on average, and treatment is associated with a high satisfaction rate among patients.

Research demonstrates that when patients who have been unresponsive to topical antiperspirants are injected with botulinum toxin, they experience a 75% reduction in sweating, an improvement in emotional and physical well-being, and a decrease in activity limitations without any serious adverse events. In our practice, we have witnessed a reduction in symptoms within two weeks of treatment, an asymptomatic period lasting an average of six to nine months, and a high patient satisfaction rate.

Primary hyperhidrosis is defined as idiopathic, excessive sweating lasting for six months or more and has at least two of the following features: impairment of daily activities, bilateral symmetric sweating, frequency greater than once a week, positive family history, onset before age 25, and cessation of focal sweating while asleep.  Focal hyperhidrosis is commonly localized to the axillae, palms, and soles and does not involve a more widespread autonomic dysfunction. Although emotional triggers enhance symptoms, hyperhidrosis is not considered a psychiatric disorder. Hyperhidrosis can also be triggered by heat and spicy food (gustatory hyperhidrosis). The etiology is unclear, but it is believed to result from a nonthermoregulatory sympathetic hyperstimulation of eccrine sweat glands. Family history analyses indicate that hyperhidrosis can be inherited in an autosomal dominant manner.

Botulinum toxin injections are not offered to patients who suffer from hyperhidrosis secondary to an underlying disease, who have undergone previous surgical debulking of sweat glands, or who have severe blood-clotting disorders. Patients who have a concurrent infection at the injection site or systemic infection are asked to return to the office after the infection has cleared. We avoid treating patients who have an existing medical condition that may interfere with neuromuscular function, such as myasthenia gravis, Eaton-Lambert syndrome, or amyotrophic lateral sclerosis. Female patients who are pregnant or breastfeeding are excluded from treatment as well.

Efficacy and Duration of Symptom Relief

Most patients report an improvement in symptoms within the first week after treatment. Following the above treatment regimen, reinjection with toxin due to initial treatment failure is rarely required. Our data and data published by others have demonstrated that botulinum toxin treatment for hyperhidrosis has an average of six to nine months of efficacy duration.

As the neurotoxin reduces all transmission of acetylcholine to the eccrine glands, both moderate and severe cases are resolved equally, in our experience. Although several patients have been referred to us who have previously experienced failed treatments, we have had very few in our own practice. Patients often state that other physicians have injected the toxin perpendicularly through a grid of perforations, possibly leading to injections that are deep within the tissue, below the presynaptic membranes of the cholinergic nerves. In our technique, the botulinum toxin is injected at a 45-degree angle into the dermis, leading to successful chemodenervation of the eccrine gland.