One form of hyperhidrosis treatment (synonym: hyperhidrosis therapy) is local injection of botulinum toxin (Botox). Approximately 0.5% of the population is affected by increased sweating, the most common form of which is called primary idiopathic focal hyperhidrosis. Less common is generalized secondary hyperhidrosis, which usually has a systemic disease as its cause (e.g., endocrinological disorders such as thyroid dysfunction, diabetes mellitus, tumors, or neurological ̶ nervous system disorders). In addition to psychosocial problems, increased sweat secretion also leads to increased susceptibility to infections from viruses, bacteria, and fungi. Botox is a natural bacterial toxin produced by the bacterium Clostridium botulinum. The procedure is used to treat hyperhidrosis, which is characterized by disturbing increased sweat production in the axilla (armpit), face, and palms of the hands and feet.
Indications (areas of application)
Abnormal sweating is distinguished from the normal state by the amount of sweat. An amount of more than 50 mg of sweat per minute in the armpit is considered pathological (pathological). Such an increase in sweating can lead to considerable psychological stress in both professional and private life. For this reason, therapy with Botox is medically indicated. This means that it is absolutely necessary. Sweat production that is below the defined limit can also be very disturbing and associated with great suffering. Here the indication is given, even if it is an aesthetic concern. However, treatment of the palms and feet is not performed for aesthetic reasons because of the anesthesia required and the increased complications.
The procedure
Hyperhidrosis treatment with Botox is exclusively for the treatment of primary hyperhidrosis. For this reason, secondary hyperhidrosis should be excluded first. The cause of hyperhidrosis is a disorder of the so-called eccrine sweat glands (glandulae sudofirae eccrinae), which are responsible for thermoregulation (regulation of body heat) of the body. These glands are supplied by the sympathetic nervous system (part of the autonomic, involuntary nervous system) via cholinergic nerves (cholinergic innervation refers to the part of the nervous system that uses acetylcholine as a neurotransmitter. A neurotransmitter is a messenger that carries electrical information from one nerve cell to the next), which are particularly activated by stress or anxiety. The Botox is injected intracutaneously (into the skin) in the affected area at a distance of 1-2 cm, so that there is a wheal. On the palms of the feet and hands, a local anesthetic is necessary beforehand, otherwise the treatment is very painful. Botox acts on the cholinergic nerves that supply the sweat glands by preventing the release of the neurotransmitter acetylcholine. The effect lasts for about 4-6 months and can be repeated as often as desired. Despite multiple applications, it has been shown that there are no clustered side effects. Minor test (iodine strength test) is available to mark the area of increased sweat production for treatment:
- Brushing the skin with an iodine–potassium iodide solution (Lugol’s solution).
- Dusting with starch powder after drying.
- If sweat is present, the area turns dark blue.
In addition to therapy with Botox, a number of other therapeutic measures are available, some of which, however, can be associated with significant side effects:
- Autogenic training
- Acupuncture
- Sage extracts (tablets, tea) – application is based on reports of experience. Controlled studies of efficacy are not available, so the substance must be considered at best as an alternative or adjuvant therapy approach.
- Antiperspirants: Local application of aldehydes or aluminum hydrochloride, which have an effect on the excretory ducts of the sweat glands and inhibit sweat secretion.
- Iontophoresis: the application of a weak sliding electric current to a salt bath, whose ions can have an obstructive effect on the excretory ducts of the sweat glands.
- Anticholinergic drugs: they cause a systemic blockade of cholinergic innervation, that is, inhibition of the release of the neurotransmitter acetylcholine.Side effects: Accommodation disorders (ability of the eye to adapt to external conditions), dry mouth, tachycardia (rapid heartbeat), micturition disorders (bladder emptying disorder), concentration disorders.
- Tranquilizers: psychotropic drugs that have a calming or relaxing effect are used when sweating is a result of anxiety reactions.
- Surgical therapy: excision of the affected tissue (eg, in therapy-resistant axillary hyperhidrosis) or sympathectomy (severing of the border ganglia and thus interruption of the supplying nerve tracts).
Benefit
Hyperhidrosis treatment with Botox is a useful medical therapy, since increased sweat production can significantly affect the patient’s social life in particular.
