Hyperhidrosis Forum

Botox overview

Botox injections represent the most popular cosmetic procedure undertaken in the US every year, with the temporary elimination of wrinkles being the foremost application. However, Botox is also used to temporarily resolve a number of bothersome medical conditions, including hyperhidrosis. In total, around 20 diverse medical and cosmetic conditions are frequently treated with Botox, although the FDA has only approved treatment of blepharospasm, cervical dystonia, axillary hyperhidrosis, strabismus, achalasia, certain types of neuropathy and migraine headaches. For patients who get limited or no side effects from Botox entering their body, it truly seems to be a magic poison. Every few months, new reports come out that Botox injections relieve some medical condition or other, and I would not be surprised if the toxin is already used for up to 100 applications.

BOTOX (all caps) is a registered trademark of Allergan. It was first approved for use on humans by the US FDA in December 1989, and approved as a treatment for underarm sweating in 2004. In recent years, hand sweating and, to a lesser extent, feet sweating have also been increasingly frequently treated using Botox.

Botulinum, Botulism or Botox?

Botulinum toxin is a neurotoxic protein produced by the bacterium Clostridium Botulinum. Botulism is a rare but serious paralytic food poison illness caused by the Botulinum toxin. Botox is the trade name for Botulinum toxin, with the capitalized version of the word being a trademark of Allergen.

Botulinum Type A (BTX-A)

Botox is classified as being Botulinum Type A (BTX-A). Besides Allergen, companies in Europe (brand names Dysport and Xeomin), South Korea (brand name Neuronox) and China also produce BTX-A. Botox is technically known as onabotulinumtoxinA, Dysport is known as abobotulinumtoxinA and Xeomin is known as incobotulinumtoxinA.

Botulinum Type B (BTX-B)

Botulinum Type B (BTX-B) received FDA approval for treatment of cervical dystonia in the US in December 2000. The main Botox Type B product sold in the US is Myobloc (known as NeuroBloc in the European Union). Myobloc is technically known as rimabotulinumtoxinB in the US.

Botox and hyperhidrosis

Botox injections are now commonly used to treat hyperhidrosis of the armpits and are extremely effective. It seems like almost everyone getting Botox injections in the armpits sees at least six months of cessation in axillary sweating. It used to be thought that the effect on hand sweating was not so great with Botox as with armpit sweating, especially since side effects such as pain while typing or doing everyday chores were often significant (not to mention that palms require far more injections than armpits, and the injections themselves can be more painful). However, at a 2010 hyperhidrosis conference, I met three people who had their palms done and had great results. One even told me that she had zero return of sweat for one year and only some return of sweat for another six months after that. Only one and a half years after getting injected did this girl see a full fledged return of original symptoms of excessive perspiration. She did tell me that for the first few months after getting injected, her hands pained when she did certain everyday tasks such as buttoning a shirt.

Feet sweating is the most difficult condition to treat with Botox, since the feet require far more injections that the hands or armpits, and also have very thick skin. See my results from having Botox injections to stop feet sweating for more.

On average, each hand requires at least 50 BOTOX injections, and each foot requires about 100 injections, while each armpit requires only around 15 injections. All these numbers can vary depending upon the size of an individual's hands, feet and armpits; the amount of sweating in each area (i.e., the intensity and area of hyperhidrosis); and the practitioner's preference and experience in treating hyperhidrosis with BOTOX injections. Armpit treatments are the most common and take just 10 minutes per armpit, with effects lasting for up to six months on average.

A good clinic or practitioner will perform an iodine starch test on the affected area first in order to check the intensity and exact areas of sweating before proceeding with the BOTOX injections application. Treating two hands or two feet typically costs about $1,000 per patient and is often covered by insurance. Armpits should cost less. For more information, see BOTOX for severe underarm sweating.

Botox versus Dysport versus Xeomin versus Myobloc

There are now many alternative brands to Botox, with Dysport, Myobloc (also known as NeuroBloc) and Xeomin being the most well known ones. Asian countries such as China and South Korea also produce their own variants. There are some differences between the above four products that necessitate different doses of each for the same type of condition being treated.

At least in some countries, it seems like Botox has been used since around 1980, Dysport since around 1990, Myobloc since around 2008 and Xeomin since around 2010. Dysport was only approved by the US FDA in 2009, Myobloc in 2010, and Xeomin in 2011.

Topical Botox

There are several products currently in development that might end up making painful Botox injections obsolete, at least for shallow delivery applications. Anterios (US) is developing a topical lotion of Botox Type A called ANT-1207. Revance Therapeutics (US) is developing a gel version of Botox Type A called RT001.

Botox related links of interest:

Botox and hyperhidrosis forum

Patient recommendations of clinics and physicians that offer Botox to treat hyperhidrosis

Locations where you can get Botox injections for hyperhidrosis

My results from having Botox injections for feet sweating