In 2004, for the first time in decades, the U.S. Food & Drug Administration (FDA) approved a new treatment for excessive sweating of the underarms (axillary hyperhidrosis). Specifically, on Monday, July 19, 2004, the FDA approved BOTOX® (botulinum toxin type A) for the treatment of severe primary axillary hyperhidrosis in patients unable to obtain relief using antiperspirants. BOTOX is produced by Allergan, Inc., of Irvine, California, and it is the most studied brand of botulinum toxin in the world. BOTOX® has been available for over a decade and has been used to treat more than 1 million patients with various conditions, including spasticity and movement disorders. With FDA approval, the United States joins more than 20 other countries that have already approved the use of BOTOX for excessive sweating.
Using local injections of botulinum toxin to alleviate the symptoms of hyperhidrosis is a promising approach. Research has shown that treating the armpits, hands, feet, and face with botulinum toxin is safe and effective. In one clinical study involving 322 patients with severe underarm sweating, 81% of the patients receiving botulinum toxin injections achieved a greater than 50% reduction in sweating. And, 50% of the patients had their excessive sweating relieved for at least 201 days (nearly 7 months).
Botulinum toxin is a natural, purified protein with the ability to temporarily block the secretion of the chemical in the nervous system that is responsible for “turning on” the body’s sweat glands. By blocking, or interrupting, this chemical messenger, botulinum toxin “turns off” sweating at the area where it has been injected.
The use of botulinum toxin for the treatment of hyperhidrosis is most effective when performed by a physician who has received special training and who has experience with the procedure.
Botulinum toxin injections can be administered in a physician’s office, require relatively little time, and do not demand any restrictions in work or leisure activity (aside from refraining from intensive exercise or the use of a sauna on the day of the injections).
During the procedure, a very fine needle is used to inject small amounts of botulinum toxin just under the skin near the sweat glands responsible for excessive perspiration. Multiple injections are given based on your doctor’s assessment of the area that needs to be treated. Injections into the palms or soles may be painful. To ease discomfort, physicians may use one or more of a number of anesthetic techniques such as pain-killing creams, nerve blocks, ice, or vibrations.
There is a possibility that during the procedures some sweat glands may be missed. As a result, you may continue to experience some sweating from the untreated areas. If this happens, it’s important to talk to your doctor so that he or she can reevaluate the sweating areas and perhaps “fill in” the gaps with additional injections.
Botulinum toxin injections do not cure hyperhidrosis; your symptoms will return gradually. Follow-up injections are required to maintain dryness. These repeat injections may be necessary at intervals varying from seven to sixteen months.