What is the protocol for using Botulinum toxin (Botox) to treat hyperhidrosis?

From the Guidelines

Botox injections for hyperhidrosis should be administered using 50-100 units of botulinum toxin type A, with the specific dosing depending on the affected area, such as 50 units per axilla for axillary hyperhidrosis or 100-200 units total for palmar hyperhidrosis, as this approach has been shown to effectively reduce sweat production with manageable side effects 1. The procedure for Botox injections in hyperhidrosis treatment involves several key steps:

• Identifying the hyperhidrotic area using either the Minor's starch-iodine test or visual inspection
• Applying local anesthesia, such as topical lidocaine cream, ice, or nerve blocks, 30-60 minutes before treatment to minimize discomfort
• Performing injections using a 30-32 gauge needle at a depth of 2-3 mm, with injections spaced 1-2 cm apart across the affected area Results from Botox injections for hyperhidrosis typically appear within 2-7 days and last 4-12 months, requiring repeat treatments to maintain effectiveness. The mechanism of action involves blocking the release of acetylcholine from sympathetic nerves that stimulate eccrine sweat glands, thereby reducing sweat production. Potential side effects include injection site pain, temporary muscle weakness (especially with palmar injections), and compensatory sweating in untreated areas. It is essential for patients to avoid massage or pressure on the treated area for 24 hours post-injection to prevent toxin spread. While there is a risk of allergic reactions to botulinum antitoxin, as reported in studies such as 1, the incidence is relatively low, and the benefits of Botox treatment for hyperhidrosis often outweigh the risks.

From the FDA Drug Label

2.2 Preparation and Dilution Technique 2.3 Administration 1 INDICATIONS AND USAGE

The FDA drug label does not answer the question.

From the Research

Botox Hyperhidrosis Protocol

• Botox is considered a treatment option for hyperhidrosis, particularly for axillary hyperhidrosis 2, 3, 4, 5, 6
• The recommended dose of Botox for axillary hyperhidrosis varies, but studies suggest that 50-100 MU per axilla may be effective 3, 5
• Botox injections are typically considered second-line treatment for axillary hyperhidrosis, after topical treatments such as aluminum chloride 2, 6
• The efficacy of Botox for hyperhidrosis has been demonstrated in several studies, with significant reductions in sweat production and improvements in quality of life 3, 5, 6
• Potential side effects of Botox injections for hyperhidrosis include injection site pain and temporary numbness or weakness, but these are generally mild and temporary 3, 5

Treatment Guidelines

• For axillary hyperhidrosis, the treatment guidelines are:
  • Topical treatment (e.g. aluminum chloride) as first-line treatment 2, 6
  • Botox injections as second-line treatment 2, 3, 5
  • Oral medications (e.g. glycopyrrolate) as third-line treatment 2, 4
• For palmar and plantar hyperhidrosis, the treatment guidelines are:
  • Topical treatment (e.g. aluminum chloride) as first-line treatment 2
  • Iontophoresis as second-line treatment 2, 4
  • Botox injections as third-line treatment 2, 4

Efficacy and Safety

• Studies have demonstrated the efficacy and safety of Botox injections for hyperhidrosis, with significant reductions in sweat production and improvements in quality of life 3, 5, 6
• The safety profile of Botox injections for hyperhidrosis is generally good, with mild and temporary side effects 3, 5