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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