From the Research
The recommended dose of botulinum toxin type A (Botox) for axillary hyperhidrosis is 50 units per axilla. This dose is based on the most recent and highest quality study available, which provides an overview of the commercially available botulinum toxin formulations and their applications in the treatment of primary hyperhidrosis 1. The treatment involves multiple intradermal injections of small amounts (typically 0.1-0.2 mL per site) distributed evenly across each axilla, with injection sites spaced approximately 1-2 cm apart.
Key Considerations
- The total dose should not exceed 100 units for both axillae in a single treatment session.
- Prior to injection, the hyperhidrotic area should be identified using either the Minor's starch-iodine test or by visually observing the area of sweating.
- Effects typically begin within 2-4 days after injection, with maximum benefit occurring around 2 weeks post-treatment.
- The therapeutic effect generally lasts 4-7 months, after which retreatment may be necessary.
- Botox works by blocking the release of acetylcholine from sympathetic nerve terminals, thereby inhibiting sweat gland secretion.
Side Effects and Safety
- Side effects are usually mild and localized, including injection site pain, bruising, and rarely, temporary muscle weakness if the toxin diffuses into nearby muscle tissue.
- Botulinum toxin injections are widely used as a second-line primary hyperhidrosis treatment option once topical treatment strategies have failed, as noted in 2 and 3.
- The use of botulinum toxin for axillary hyperhidrosis has been supported by various studies, including 4 and 5, which demonstrate its efficacy and safety in treating this condition.