From the Guidelines
For treating hyperhidrosis with Botox, the recommended dilution is typically 100 units of Botox diluted in 4-5 ml of preservative-free normal saline (0.9% sodium chloride). This creates a concentration of approximately 2-2.5 units per 0.1 ml. Although the provided evidence does not directly address the dilution of Botox for hyperhidrosis, the recommended dilution is based on established clinical practices and guidelines.
Key Considerations
- The dilution is important because it allows for appropriate distribution of the toxin across the treatment area while maintaining efficacy.
- More dilute solutions (using 4-5 ml rather than 1-2 ml) allow for wider spread of the medication and better coverage of the affected sweat gland area.
- The injections are typically administered intradermally in a grid pattern across the hyperhidrotic area, with each injection point receiving a small amount (0.1-0.2 ml) of the diluted solution.
Treatment Areas and Dosage
- For axillary hyperhidrosis (underarms), a total dose of 50 units per axilla is standard.
- For palmar hyperhidrosis (hands), 100-200 units total may be used.
- For plantar hyperhidrosis (feet), similar dosing to palmar treatment is used. The effects of Botox for hyperhidrosis typically last 4-6 months before retreatment is necessary, as noted in various clinical studies, although not specifically mentioned in the provided evidence 1.
From the Research
Botox Dilution for Hyperhydrosis
- The ideal dilution of botox for hyperhydrosis is not explicitly stated in the provided studies, but the dilution of botox in lidocaine or normal saline is discussed in terms of efficacy and pain tolerance 2, 3.
- A study comparing the efficacy and tolerance profile of saline-diluted botulinum toxin A and lidocaine-diluted botulinum toxin A in patients with axillary hyperhidrosis found that both treatments were similarly effective, but lidocaine-diluted botulinum toxin A was associated with significantly reduced pain 2.
- Another study comparing the efficacy, safety, and pain tolerance of lidocaine-diluted BTX-A vs. saline-diluted BTX-A for the treatment of axillary hyperhidrosis found that lidocaine-diluted BTX-A caused significantly less pain than BTX-A diluted in saline, while being equally effective and safe 3.
- The volume of dilution is mentioned in some studies, with 0.5 mL of saline and 1 mL of 2% lidocaine used in one study 3, and an equal volume of saline used in another study 2.
- However, the optimal dilution ratio of botox for hyperhydrosis is not clearly stated in the provided studies, and more research may be needed to determine the ideal dilution ratio.
Treatment Options for Hyperhydrosis
- Botulinum toxin injections are considered a treatment option for hyperhydrosis, particularly for axillary, palmar, plantar, or craniofacial hyperhidrosis 4, 5.
- Other treatment options for hyperhydrosis include topical medications, iontophoresis, oral anticholinergics, and surgery 4, 5.
- The choice of treatment depends on the severity and location of the hyperhydrosis, as well as the patient's medical history and preferences 4, 5.