Botulinum Toxin & Hyperhidrosis

Axillary hyperhidrosis

Axillary hyperhidrosis is a common and debilitating condition.
The traditional treatment relied on aluminum salts applied locally, oral anticholinergics, and, in case of failure, excision of the sweat glands or thoracoscopic thoracic sympathectomy.

Thoracic sympathectomy removes the thoracic ganglia and is generally effective for hand moisture but less so for axillary hyperhidrosis. Complications, vascular, nerve-related (chronic pain, Claude Bernard Horner syndrome), or pleural (hemothorax, chylothorax) can occur, and there is often compensatory sweating (back, legs) leading to a low satisfaction rate.

Treatment with botulinum toxin injected into the axillary dermis is interesting; it works by inhibiting the release of acetylcholine by the nerves responsible for sweating, reducing it and improving quality of life.

Even if it may need to be repeated, botulinum toxin therapy can be proposed as a first-line treatment for severe axillary hyperhidrosis.

Botulinum toxin

Botulinum toxins work by blocking nerve impulses to the muscles. In addition to blocking this nerve impulse to the muscles, botulinum toxin also blocks all nerve signals carried by a chemical called acetylcholine. Acetylcholine is the key to the functioning and purpose of botulinum toxins. It is a chemical released by nerve endings and serves to transport the nerve impulse across the tiny space between the nerve ending and its target.

The treatment takes a few minutes and requires no special precautions. However, you should inform the doctor if you are taking anticoagulant medications, certain antibiotics, or if you have a neuromuscular disease.

The therapeutic effect of botulinum toxin generally manifests after a few days and lasts for 3 to 6 months. A small bruise that quickly resolves and a temporary discomfort may occur at the injection sites.

Possible side effects of the treatment include excessive weakness of the injected muscle or surrounding muscles. These side effects are dose-dependent and reversible within a few days or weeks. The therapeutic effect of botulinum toxin being temporary, injections can be repeated in case of recurrence of symptoms. The frequency of injections is limited to a maximum of one series of injections every 3 months to avoid or delay the development of resistance to treatment. Indeed, a small number of patients (about 1 to 3%) develop antibodies against botulinum toxin sooner or later, which diminishes or abolishes the beneficial effect of the treatment.