What is the role of botulinum toxin (BOTOX) injections in axillary hyperhidrosis treatment?

Updated: Feb 12, 2019
  • Author: Richard H S Karpinski, MD, FACS; Chief Editor: Gregory Gary Caputy, MD, PhD, FICS  more...
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Botulinum toxin A blocks neuronal acetylcholine release at the neuromuscular junction and in cholinergic autonomic neurons; it thus disconnects axillary sweat glands from their innervation. In an elegant study, Heckmann et al demonstrated quantitatively the effective safe treatment of axillary hyperhidrosis by intradermal injection of botulinum toxin A. They also demonstrated the longevity of the relief produced: 24 weeks after the injection of 100 U, the rates of sweat production (in the 136 patients in whom the rates were measured at that time) were still lower than baseline values (67 ± 66 mg/min in the axilla that received 200 U and 65 ± 64 mg/min in the axilla that received placebo and 100 U of the toxin).

A study by Brehmer et al indicated that the duration of botulinum toxin A’s effects in primary axillary hyperhidrosis increase with successive treatments. The first injection, in 101 patients, had a median efficacy of 4.0 months, compared with 4.5 months for the second treatment and 5.0 months for the third injection. [11]

BOTOX® injections have become an established and, often, effective treatment for axillary hyperhidrosis. This treatment has also raised the profile of the condition with insurers. Although effective, the success of the treatment seems to be quite technique-dependent (ie, the treatment works when injections are done by one practitioner and not when done by another). Major drawbacks are the expense of the toxin and the need for repeated treatments.

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