Botox for Palmar Hyperhidrosis

What causes excessive palmar sweating?

Hyperhidrosis is the medical term for excessive sweating, and when it occurs on the palms it is called “palmar hyperhidrosis.” This is caused by stimulation of the eccrine sweat glands (pronounced ek’-krine) by the nerve endings which are the final nerve pathways from higher centers in the brain. These nerves respond to different kinds of stress – emotional stress like intimate social situations or public speaking, or physical stress like the increased body temperature that comes with exercise or hot and humid weather. Some people are plagued with excessive sweating. Other people are bothered only when they are under emotional stress, physically active, or over-heated. In either case, Botox® Purified Neurotoxin Complex* may be the answer. The nerves that control sweating depend upon a chemical transmitter called acetylcholine. Botox® is a genetically engineered neurotoxin which can, when injected into the skin, block the release of the acetylcholine to the sweat glands for months!

What are the alternative treatments?

Topical Antiperspirants
Topical antiperspirant sticks, creams, lotions, and solutions typically use aluminum chloride solutions. They are highly irritating with continued use, and largely ineffective for people with excessive sweating.

Anti-cholinergic drugs & tranquilizers
Medications currently used cause dry mouth, blurred vision and minimally reduce sweating. .

Tap Water Iontophoresis
Various battery powered electrical devices have been used over the years which use a tap water moistened pad and electrical current held against the palms for several hours. This decreases the sweating but is very time consuming, needs to be repeated on a daily or weekly basis, and is only mildly effective for severe cases.

Thoracic surgeons and neurosurgeons use a fiber-optic surgical tube inserted into the neck or through the underarm skin to cut the nerve fibers next to the spine which lead to underarm sweat glands and palms (endoscopic sympathectomy or ETS). This approach involves the risk of localized paralysis, loss of sensation, and even drooping eyelid or permanent dilation of the pupil of the eye as reflex injury. Cases of compensatory hyperhidrosis where there is an unwanted increase in sweating elsewhere have been reported.


How is BOTOX® given?

A very small needle is used to inject small drops of Botox® into the palmar skin of the hand in approximately 30 places. The procedure takes only a few minutes in the office and requires no anesthesia. Heavy physical exercise should be avoided for several hours, but patients may engage in any normal activity. We prefer to treat one hand first and the other hand in one week.


When will BOTOX® take effect?

Your palmar sweating will decrease within 48 hours and the full effect will be seen in about 1 to 2 weeks.


How long does BOTOX® last?

Most patients will obtain 6 to 10 months of dryness after treatment with Botox®.


What are the risks and complications?

The only complications from injection into the palmar skin are:
1) Tiny bruises are occasionally seen which fade in a few days.
2) Occasionally small persistent areas of sweating may need a second treatment session.
3) Some temporary weakness in grip strength which may last up to two weeks. There is no risk of numbness, or permanent weakness.


Who are good candidates for “No Sweat” Botox®?

-People with unwanted palmer sweating

-People working close to others who need to touch:
hairstylists, nurses ,dentists and hygienists, MD’s.

-People working in retail who handle sensitive material: salespeople in clothing, jewelry, stationary, accessories.

-People working in hot conditions: models, television newscasters, chefs and photographers

-People handling lots of paper: executives, attorneys, salesmen, stockbrokers and title company workers

-People who need to use keyboards extensively: typists, computer programmers and software engineers.

-People who handle money: cashiers, tellers and reception desk personnel.


What conditions does this treatment help?

Tired of slipping on steering wheels?
Tired of magazines coming off on your hands?
Tired of reading the newspaper and wearing the ink?
Tired of ruining your handwritten letters and notecards?
Tired of avoiding shaking hands with new people?
Tired of feeling bad about it?


“No Sweat” BOTOX® for Hyperhidrosis

Please email us or contact our office for an appointment. Any and all references herein to ‘Botox®‘ refer to ‘Botox® Purified Neurotoxin Complex’, which is a registered trademark of Allergan *Botox® Purified Neurotoxin Complex is an FDA approved medication for various kinds of muscle spasm and spastic rigidity, but has been specifically approved for the treatment of hyperhidrosis only in the axillary (underarm) area. The use of Botox® for treatment of palmar sweating is a so-called “off label” use. The FDA recognizes the common practice among physicians to use FDA approved drugs in so-called “off label” uses, particularly in diseases and conditions for which there are lesser alternatives. Botox® Purified Neurotoxin Complex is a registered trademark of Allergan Herbert Laboratories, Inc.