II.  Excessive Sweating Causes

There are many triggers (anxiety, stress) but the exact cause is really unknown.

III. Treatment

The first line of excessive sweating treatment is medical-grade deodorants.  Unfortunately, these usually do not help much.  Many other things have been tried - topical medications, oral medications, iontophoresis, and surgery - but they have not proven to be very effective in the majority of patientsUntil recently, there was really no other solution.  Now there is an exciting new treatment for excessive sweating that is even sometimes covered by insurance - Botox injections.  Botox provides an effective temporary relief from this embarrassing condition.

What is Botox?
Botox is the trade name of Botulinum Toxin Type A. This toxin blocks nerve impulses when injected into the muscles that cause frown lines. Once the muscle(s) can no longer contract, the action of frowning is stopped, and frown lines diminish. Now you can soften and reduce frown lines without surgery and without scars. However, experimental studies have recently revealed that it helps patients with hyperhidrosis.  It typically reduces the amount of sweating by 70-90%!

How is the procedure done?

Botox is currently used in our office to decrease excessive sweating in the underarms (axillae), palms (hands), and soles (feet).  Prior to the injections, a topical anesthetic ( ELA-Max) is placed on the skin.  The cream is left in place for 20 - 30 minutes to numb the skin prior to the injections. The topical anesthetic is usually the only pain control necessary for the injections in the under arm.  If the palms and soles are to be injected, the physician may choose to perform a nerve block that numbs the entire hand or foot.  These nerve blocks consist of 3-4 injections per hand or foot using a small needle.  After the injection, the treated hand or foot will feel numb for 30 minutes to one hour.  You are advised not to drive for 2 hours after having these anesthetic injections because they may interfere with your ability to drive.

After the area to be treated has been numbed with topical cream or the injections, Botox injections are performed in the area to be treated.  The needle that is used is a 30 gauge needle which is the same size as an acupuncture needle.  Approximately 40 injections will be performed in each hand or foot or 20 injections per underarm.

After the injections, the skin may appear slightly bruised, and the skin will feel numb from the anesthesia. After 2 hours, normal activities can be resumed including exercise.  

The most common side effect of this procedure is bruising and mild soreness in the treated areas.  Because this treatment is also used to relax muscles, it is possible to develop decreased muscle strength in the treated areas.  This is most often noticeable in the hands and is most bothersome to tennis players, piano players, and others who rely on good muscle strength in the hands.  Although this side effect is not common, it does occur and may last for a few months in some individuals.  Other side effects associated with the same dose of Botox in the clinical trials examining its use in cervical dystonia include dry mouth, muscle soreness, and dyspepsia (indigestion).  These side effects are all temporary.

When does Botox start to work & how long does it last?
The results of a Botox treatment start to appear in 3 to 10 days. The treated area will start to gradually regain its sweating propensity over 3 to 9 months. When sweating starts to reappear, a simple repeat treatment is all that is necessary to maintain the desired result.

**Botox, when used by an experienced physician, is a safe and effective way to eliminate the embarrassing problem of excessive sweating of the underarms, hands and feet.


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