Botox or iontophososis: Which one gives a better result?

I have coauthored a textbook on hyperhidrosis and continue to see very positive results with injections of Botox to the areas of excessive sweat. Best, Dr. Karamanoukian Los Angeles

Thank you for your question. Botox is a very effective treatment for hyperhidrosis (armpit, hands, feet, scalp/face, etc). The dosing is typically based on areas treated but can vary around 50 - 100 units per side depending on how large the treatment area. Duration also depends on dose and technique, but can vary from 3-6 months. For the armpit region, you may also want to consider miraDry as it provides a longer lasting relief and in the long run is more cost-effective.  Iontophoresis is much less predictable with effectiveness.

The short answer is neither is the most effective way to treat your problem.  Miradry is the best way to correct your problem. Excess sweat (hyperhydrosis), and smelly armpits (bromhydrosis) are caused by eccrine (sweat) and apocrine glands whose secretion is modified by bacteria causing a bad odor. Miradry eliminates these glands permanently and solves both problems. You will never need to use deodorant again.

If you have hyperhidrosis in your armpit, I recommend mirDry as the treatment.  It is FDA approved and it has significant lasting durability. 

For excessive sweating over the palms, soles and in the underarm region, BOTOX is way better than iontophoresis. 

Botox Therapeutic is very useful for hyperhidrosis, especially in the most bothersome areas which include axillae,palms and soles.It is also useful for excess scalp and forehead sweating.When injected properly, results can last for 6 to 9 months. Iontophoresis is useful, as can be done at home, but is difficult to use in the armpits and scalp and forehead.

Just to clarify some inaccuracies I'm seeing about iontophoresis vs. Botox.  As a physician who has prescribed iontophoresis to my hyperhidrosis patients for many years, iontophoresis does not require 2-3 hours of treatment each time.  The standard treatment protocol is just 20 minutes for palms and 20 minutes for soles.  So 40 minutes total for both palms and soles. This should be done intensely 3-4x/week for 2-3 weeks in a row for initial good control of the sweating, and then can be tapered down to a maintenance regimen of once a week or less for most people.  Insurance companies will cover iontophoresis treatment and the cost of purchasing the treatment device for home use more readily than Botox treatment.  I also have treated many people with Botox for hyperhidrosis as well.  Botox treatment of palm/soles carries the unique risks of possible hand muscle weakness if some diffuses too deep, and severe pain with treatment.  Nerve blocks can be done prior to the treatment, but these are very painful as well.  Iontophoresis has mild tingling/burning if at all and often no significant pain.  Botox treatment of the axillae is preferred over iontophoresis because the armpit treatment pads for iontophoresis are ineffective.  MiraDry is wonderful permanent armpit sweat treatment that in my opinion surpasses Botox for armpits in efficacy and long term cost.

Iontophoresis is most commonly used for hyperhidrosis of the palms or feet. If you have nothing better to do than to soak your hands in a bath for 2 hours 3 times a week, then iontophoresis is ideal for you. Botox works, is durable, and lasts 3-6 months and is very highly effective - > 98% success. Iontophoresis is cumbersome, messy and gives 30-40% improvement in palmar hyperhidrosis and less for plantar (foot) areas because of the thicker skin. 

Both botulinum toxin and iontophoresis will work to decrease sweating/hyperhydrosis. Botox is certainly easier to have done and one treatment usually lasts 5-6 months. With the iontophoresis you have to continually submerge the affected area 3-4x a week to maintain results. I would suggest finding a dermatologist who performs Botox for this and make an appointment. 

BOTOX is better. Depending on where you sweat, a certain amount will be needed. As a guide, Botox to the underarms will need 50 u each side, and last 5-6 months. In Australia it is subsided by Medicare and the PBS. You are allowed 3 subsidised treatments per year. For hands and feet you will need 80-100 plus units for each hand or foot. This makes the treatment very expensive. It is not subsidised in Australia. Iontophoresis for these areas maybe a cost effective option. But to answer your question, BOTOX works better then even Glyco Ionto, as it last 2-4 months in these areas. Dr Davin Lim Brisbane, Australia.