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

From the Guidelines

Botox is an effective treatment for axillary hyperhidrosis, with a standard protocol involving 50 units per axilla injected intradermally, although the provided evidence does not directly support this protocol for axillary hyperhidrosis, it is a widely accepted treatment in clinical practice. The procedure for Botox treatment of axillary hyperhidrosis typically begins with identifying the hyperhidrotic area using either the Minor's starch-iodine test or by visually observing the sweaty region. After cleaning the skin with alcohol, Botox is injected in a grid pattern with multiple small injections spaced 1-2 cm apart throughout the affected area, using a 30-gauge needle at a depth of 2-3 mm. The total dose typically ranges from 50-100 units per axilla depending on severity, with each injection point receiving 1.5-2.5 units. Local anesthesia (topical lidocaine cream applied 30-60 minutes before) or ice can be used to minimize discomfort. Patients should avoid intense physical activity for 24 hours post-treatment and should be informed that results typically appear within 2-7 days, with effects lasting 4-7 months. Retreatment is necessary when symptoms return. Botox works by blocking the release of acetylcholine from sympathetic nerves that stimulate sweat glands, effectively reducing sweat production. Side effects are minimal but may include temporary pain, bruising, or compensatory sweating in other body areas, however, the provided study 1 discusses the use of botulinum toxin for the treatment of hoarseness caused by spasmodic dysphonia, not axillary hyperhidrosis. In clinical practice, the treatment of axillary hyperhidrosis with Botox is based on the principle of reducing sweat production by blocking the release of acetylcholine, and the standard protocol is widely accepted despite the lack of direct evidence in the provided study. The key points to consider when treating axillary hyperhidrosis with Botox include:

• Identifying the hyperhidrotic area
• Using a grid pattern for injections
• Administering 50-100 units per axilla
• Minimizing discomfort with local anesthesia or ice
• Informing patients of potential side effects and the need for retreatment.

From the FDA Drug Label

2.2 Preparation and Dilution Technique 2.3 Administration 14 CLINICAL STUDIES

The Botox axillary hyperhidrosis protocol is not explicitly stated in the provided drug label. However, administration and clinical studies sections may contain relevant information.

• The dosage and administration section may provide guidance on how to prepare and administer the drug.
• Clinical studies may provide information on the efficacy and safety of the drug for axillary hyperhidrosis. Since the label does not directly address the question, no conclusion can be drawn about the specific protocol for Botox axillary hyperhidrosis treatment 2.

From the Research

Botox Axillary Hyperhidrosis Protocol

• The treatment of axillary hyperhidrosis with botulinum toxin is a safe and effective option, as stated in the study by 3.
• The protocol involves the injection of botulinum toxin into the affected area, with the dosage and technique varying depending on the medical experience of the practitioner, as mentioned in the study by 3.
• The identification of the affected area is crucial to avoid wastage of the drug and to enhance efficacy, as the hyperhidrotic location may not match the hairy axillary region, as noted in the study by 3.
• The effects of botulinum toxin can last for several months, with studies showing a significant reduction in axillary sweating, as reported in the studies by 4, 5, and 6.
• The treatment has been shown to improve the quality of life of patients, with a significant reduction in symptoms and an improvement in the Dermatology Life Quality Index (DLQI) score, as reported in the study by 4.
• The protocol for treating axillary hyperhidrosis with botulinum toxin involves the injection of 100-125 units of botulinum toxin type A into the affected area, as described in the studies by 5 and 6.
• The treatment is associated with a high satisfaction rate among patients, with minimal side effects, as reported in the studies by 5 and 7.

Efficacy and Safety

• The efficacy of botulinum toxin in treating axillary hyperhidrosis has been demonstrated in several studies, with a significant reduction in axillary sweating and an improvement in quality of life, as reported in the studies by 4, 5, and 6.
• The safety of botulinum toxin has also been established, with minimal side effects reported in the studies by 5 and 7.
• The treatment is considered a safe and effective alternative to other treatments for axillary hyperhidrosis, as stated in the study by 3.

Treatment Techniques

• The treatment technique involves the injection of botulinum toxin into the affected area, with the dosage and technique varying depending on the medical experience of the practitioner, as mentioned in the study by 3.
• The use of a guide for pretreatment evaluation, injection techniques, and posttreatment care is recommended, as described in the study by 7.
• The treatment can be performed in a clinical setting, with minimal equipment and training required, as noted in the study by 7.