Botulinum toxin is a naturally occurring protein produced by the bacterium Clostridium botulinum. There are currently two different types of botulinum toxin commercially available in the United Kingdom: Type A toxin: Botox (Vistabel), Dysport (Azzalure) and Xeomin (Bocouture) and Type B toxin: Neurobloc.
Botulinum toxin type A, commonly known as ‘Botox’, is a treatment given by injection into the skin. It is licensed in the UK for treating localised hyperhidrosis of the armpits (axillae). This drug has been used for many years to treat muscle spasms affecting the face, eyes and neck and for foot problems in children with cerebral palsy. It is also used widely used for cosmetic purposes.
Botox is a preparation of protein which, when small doses are injected into the skin, blocks the nerves that supply the eccrine glands; this prevents the glands from producing sweat.
The treatment is not a cure for hyperhidrosis – it only provides temporary relief. It needs to be repeated every three to six months for maximum effect.
Although Botox injection is not licensed in the UK for palmar (hands) or plantar (feet) hyperhidrosis, it can be performed at some private hospitals. The skin in these areas is sensitive, and the treatment can therefore be painful unless an anaesthetic is applied. It would need repeating every 4 months or so, and so a general anaesthetic each time is not generally recommended, but a local anaesthetic can be given.
Botox is usually considered when topical treatments such as antiperspirants, iontophoresis and medications have been unsuccessful. Botox is only effective in treating small areas and is therefore not a viable option for treating generalised hyperhidrosis.
When Botox is injected, the toxin blocks the chemical messenger sent to your sympathetic nerves and so it does not reach the sweat glands. Without the chemical message, the glands cannot turn on the sweating. Botox permanently blocks the nerve endings and so sweat cannot be produced. Within 6-12 weeks, your body starts to produce new nerve endings. These new endings can receive the message to turn those particular sweat glands on, so mild sweating returns. Within 4-12 months, all of the new nerve endings have been produced and the chemical message can be received, turning all of the sweat glands on again. Sweating returns to normal and the treatment has finished.
The physician will have a consultation with you before the treatment. This helps to determine where sweating occurs at its worst and to ensure that you have no health problems that Botox may interfere with or worsen. You will then be told the possible side effects of the procedure to forewarn you of any unwanted symptoms. It is important to note that you will be awake during the procedure and this is perfectly normal and common practice.
Firstly, the site of injection will be cleaned to avoid infection. Secondly, any anaesthetic that is required will be administered, but this is generally not necessary in the axillae. Thirdly, you will be injected with a very fine needle which will introduce the Botox. Botox is used most frequently with sweating under the arms (axillae), with each armpit administered around fifteen injections which are completed relatively quickly.
Aftercare and possible side effects:It can take up to a week for the Botox to start working properly so it is important not to expect a miraculous disappearance right away. Your physician may ask you to avoid massaging the area or putting pressure on the injection site for a few days, and to avoid strenuous activity. The site may be a little painful and small bruises can form, but these symptoms go away within a day or two.
Many patients experience muscle weakness when they have had botox, but this does wear off eventually. Some patients have experienced an increase in sweating in another part of the body.
The Botox treatment can often cause flu-like symptoms, tiredness and blurred vision, possibly arm and neck ache for those who have injections in their armpits. These are all temporary symptoms and should disappear in a few days, and not everyone experiences them. There are no severely uncomfortable sensations or effects which should affect your daily life and there are rarely any complications