Hyperhidrosis is a condition with an excessive and profuse perspiration (sweat). In axillary hyperhidrosis, the slightest emotional or mental activity leads to wet armpits, showing up as stains on clothes, which can be socially embarrassing. Furthermore, skin maceration and subsequent microbial infection lead to discomfort, and body odors can impede social contacts. Palmar hyperhidrosis leads to a slippery grip and to a cold, wet handshake. Certain occupations are impossible because of staining of paper or other materials handled. Several treatments have been offered to patients suffering from hyperhidrosis but they were either of limited effectiveness or had numerous side-effects. With the discovery of botulinum toxin A for the treatment of hyperhidrosis, a treatment is available which relieves the symptoms in a relatively simple and safe fashion, although only for a limited time.
Botulinum toxin (BTX) is a neurotoxin produced by the anaerobic bacterium Clostridium botulinum. It inhibits the release of acetylcholine at the pre-synaptic nerve endings of the motor endplates. It has been recognized as the cause of botulism, a frequent fatal form of food poisoning. And it is widely known as the treatment option for muscle spasms and cosmetics.
Seven serotypes of BTX exist; of these, serotype A is the most effective. BTX-A exerts an inhibitory effect by preventing the exocytosis of acetylcholine, in the cholinergically innervated eccrine secretory cells and thus reduces sweat production.
About 50-200 units of BOTOX® (commercial form) are injected intradermally. Injection in the axillae is usually well tolerated without anesthesia. Injections in palms and soles can be very painful and are therefore best performed under regional anesthesia.
A drawback of this treatment is the limited duration. After treatment, anhidrosis lasts with a median duration of approximately 7 months. Repeated treatments are necessary but adverse effects of the treatment with BTX-A are minor and very rare.
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