Botulinum toxin (Botox®): the poison that helps against sweating

Botox®: a neurotoxin against sweating

The active ingredient botulinum toxin, known to most people as the drug Botox®, is a neurotoxin that blocks the transmission of impulses from the nerve cells to the muscles and thus paralyzes them. The toxin is one of the most toxic of the known neurotoxins.

The use of Botox® is especially useful if excessive sweating is limited to one body area (focal hyperhidrosis). For use in hyperhidrosis therapy, Botox® can therefore be used for the treatment of excessive perspiration of the feet, hands, underarms, face, or head.

Botulinum toxin: a debilitating toxin that paralyzes nerve transmission

Injecting botulinum toxin into the affected skin area blocks the signalling of the neurotransmitter acetylcholine. The sweat glands can no longer receive the exaggerated signals from the central nervous system and the excessive sweating stops. Unlike other therapies, treatment with Botox® does not result in permanent relief of hyperhidrosis. A repeat of the treatment is required approximately every 6 months as the blocking of the nerves leading to the sweat glands is reversible.

Botox® against sweating: a painful treatment option

During treatment, the highly diluted botulinum toxin is injected into the affected skin area. First, the injection points are marked and the skin is disinfected. To treat an underarm, an average of 25 injections are necessary. Since the treatment of sensitive skin area (hands, feet, armpits, or face) can be very painful, local anaesthetics are also used to relieve pain during treatment.

Botox® treatments can be performed on an outpatient basis.

Side effects of Botox® treatment for hyperhidrosis

After treatment, pain, swelling, redness, tingling, itching, and bruising may occur. It can also lead to injuries of nerves or vessels and disruptions of fine motor skills such as weakening of the hand muscles or a loss of the sense of touch. Some patients report general malaise, headaches, and back pain after treatment, and some report compensatory sweating in other parts of the body.

Treatment with Botox® is generally not without its risks. There is the risk of infection at the puncture sites, the patient may not tolerate the neurotoxin, and it can lead to interactions with other drugs (antibiotics, anaesthetics, and muscle relaxants).

When should Botox® not be used?

Botox should not be used with certain pre-existing conditions (serious muscle and nerve disorders), during pregnancy and breast-feeding, and when patients have an increased tendency to bleed.

How much does a Botox® treatment for hyperhidrosis cost?

The cost of a Botox® treatment is usually between 500 and 1000 euros. It should be noted here that the treatment must be performed approximately twice a year, which makes this therapy process very expensive over the long term.

Is Botox® covered by health insurance?

Whether statutory health insurance will cover the treatment is uncertain. In individual cases, the costs for a Botox® treatment will be covered, but only in particularly severe cases and when all other treatment options have been exhausted or cannot be used. We recommend asking your insurance company before beginning treatment.

Benefits and risks of Botox® compared to HIDREX iontophoresis

Treatment with Botox® can be painful and is not without its risks. There is a risk of side effects and the treatment must be repeated every 6 months. Its cost is very high compared to that for iontophoresis. HIDREX iontophoresis treatment offers similar results in the same treatment areas as the Botox® treatment with no long-term side effects.

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