Can Botox treat hyperhidrosis?

Botox is FDA approved to treat primary axillary (arm pit) hyperhidrosis. It was approved for this indication in July of 2004. The drug blocks the nerve function to the nerves that stimulate sweating. When a practitioner performs this procedure, he or she normally dilutes it more than he or she would when treating wrinkles on the face. This allows more diffusion of the product in the area being treated. Some practitioners sprinkle corn starch in the area prior to injecting, which turns purple-colored in the areas that are most actively producing sweat. We then can make sure to focus our injections in those locations before moving on to the rest of the area.  Sweating in the treated areas is usually significantly reduced for up to 6 months.  Off-label use for Botox treatment for hyperhidrosis includes injecting the palms and soles, which works great but is often quite uncomfortable to receive.  Some insurance companies will pay for Botox injections under the arms when the physician/PA/NP documents treatment failure on other, less costly prescriptions (such as Dry-Sol, for example).

Botox is extremely effective for Hyperhidrosis.  According to a study published in The Journal of Drugs and Dermatology this year that compared Aluminum Chloride deodorants (Drysol) to Botox, patients had 92% satisfaction with Botox vs. only 29% with the Aluminum Chloride deodorant after 4 weeks.  Injections done by a qualified practictioner cause minimal discomfort and effects normally last about 6 months.

Hyperhydrosis, also known as excessive sweating, can range from mild to extreme. When hyperhidrosis is extreme, it is not just an annoying condition, it can be disabling. The excessive sweating of the hands can make it difficult to work. When it affects the underarms, it can drench your clothes in sweat. When it affects the feet, it can lead to horrible fungal infections which make even walking difficult. Treatment with Botox is FDA approved and very effective. Some insurance companies may even be willing to reimburse you for the cost of treatment. If you intend to try to get reimbursement from your insurance company, be aware that there are a few hoops you need to jump through to have a chance at getting some money back. First, make sure the doctor uses a vial of Botox that is specifically labeled for therapeutic use. The therapeutic vials and the cosmetic vials both contain exactly 100 units of Botox, but the therapeutic vials have a different NDC number. I have seen some insurance companies reject the claim because the wrong NDC  number was submitted. (In my opinion, that sort of rejection is completely unethical, but insurance companies are in the business of making money, not in the business of helping people). Second, make sure you have tried some other treatment, such as drysol applied to the affected area. Again, insurance companies may reject your claim unless you have tried and failed using some less expensive alternative before you try Botox. Botox can be injected into axilla (underarms) with very little discomfort. I use a 33 guage needle, which makes it almost painless. On the otherhand, Botox injections into the palms or soles is very painful. In order to inject these areas, I perform a nerve block. The nerve block is very effective, but it might make your hands or feet too numb to drive home, so make sure you have a driver to take you home after the treatment. Michael Sinclair, MD