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Botulinum Toxin for Hyperhidrosis

A Review

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Abstract

Primary focal hyperhidrosis is a disorder of idiopathic excessive sweating that typically affects the axillae, palms, soles, and face. The disorder, which affects up to 2.8% of the US population, is associated with considerable physical, psychosocial, and occupational impairments. Current therapeutic strategies include topical aluminum salts, tap-water iontophoresis, oral anticholinergic agents, local surgical approaches, and sympathectomies. These treatments, however, have been limited by a relatively high incidence of adverse effects and complications. Non-surgical treatment complications are typically transient, whereas those of surgical therapies may be permanent and significant. Recently, considerable evidence suggests that botulinum toxin type A (BTX-A) injections into hyperhidrotic areas can considerably reduce focal sweating in multiple areas without major adverse effects. BTX-A has therefore shown promise as a potential replacement for more invasive treatments after topical aluminum salts have failed. This article reviews the epidemiology, diagnosis, and management of primary focal hyperhidrosis, with an emphasis on recent research evidence supporting the use of BTX-A injections for this indication.

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Acknowledgments

No sources of funding were used to assist in the preparation of this review. Nowell Solish has received honoraria from Allergan for speaking on the use of botulinum toxin for hyperhidrosis. The other authors have no conflicts of interest that are directly relevant to the content of this review.

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  1. Faculty of Medicine, University of Toronto, Women’s College Hospital, Toronto, Ontario, Canada

    Alexander Grunfeld

  2. Division of Dermatology, University of Toronto, Women’s College Hospital, Toronto, Ontario, Canada

    Christian A. Murray & Nowell Solish

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Grunfeld, A., Murray, C.A. & Solish, N. Botulinum Toxin for Hyperhidrosis. Am J Clin Dermatol 10, 87–102 (2009). https://doi.org/10.2165/00128071-200910020-00002

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