Botox, or botulinum toxin type A, is commonly known as a wrinkle treatment, but recently the U.S. Food and Drug Administration (FDA) also approved it for the treatment of severe underarm sweating, a debilitating condition called primary axillary hyperhidrosis.
"Hyperhidrosis as a chronic condition that negatively impacts people's quality of life and their ability to participate in normal work and social activities," says Los Angeles plastic surgeon Peter Fodor, MD, president of the 2200-member American Society for Aesthetic Plastic Surgery (ASAPS). "As a result of the FDA's approval of Botox as a treatment for this condition, many people who have previously elected not to undergo surgical treatment for excessive armpit sweating (hyperhidorsis) or have even been too embarrassed to discuss it with a physician may now feel more comfortable about seeking help."
According to a recent article in ASAPS' peer-reviewed publication, Aesthetic Surgery Journal (ASJ) , hyperhidrosis can be characterized by excessive sweating of the forehead, underarms, palms, or soles of the feet. The condition is believed to affect at least one percent of the population.
There are two types of hyperhidrosis: primary and secondary. Nervous system dysfunction is the suspected cause of primary hyperhidrosis. Since the condition tends to run in families, it may be genetically based. Secondary hyperhidrosis can be caused by medications, medical conditions, drug use or menopause, and treatment often may be less effective than with primary hyperhidrosis.
The FDA has approved Botox for cases of primary axillary hyperhidrosis in which results of treatment with topical agents, such as metal salts, have proved inadequate. In these difficult cases, Botox has been shown to be effective. "Botulinum toxin works by actually inhibiting sweat gland stimulation," says New York plastic surgeon and ASAPS member Alan Matarasso, MD, co-author of the ASJ article. "Use of Botox for hyperhidrosis has resulted in uniformly good results, few complications and high patient satisfaction."
The effectiveness of Botox in reducing excessive sweating is well documented. Patients participating in studies of Botox therapy for hyperhidrosis have been reported to show rapid improvement in their condition, with dramatic reduction of sweating. Results last from four to 22 months, with an average of around six months. Reported side effects are uncommon but can range from bruising and itching to temporary muscle soreness and gastrointestinal discomfort. "When using Botox to treat hyperhidrosis, the injection technique is important, as is the doctor's knowledge of anatomy in the areas to be treated," says Dr. Matarasso. "Board-certified plastic surgeons have the knowledge and experience to effectively perform these procedures."
Relatively large amounts of Botox may be needed, and the cost can be as high as $1200 per treatment. However, many patients suffering from this chronic disease feel that the benefits of effective treatment far outweigh the costs.
"Unless you or someone you know has severe hyperhidrosis, it is very difficult to imagine how devastating a problem it can be," says Dr. Fodor. "Fortunately, plastic surgeons now have an excellent, non-surgical, minimally invasive FDA-approved treatment that can help our patients lead normal lives."