Hyperhidrosis

Axillary Hyperhidrosis
 

 

For axillary symptoms, botulinum injections are very effective.  The treatment can last six to nine months before it needs repeating.

Typically 50 to 200 units of Dysport botulinum toxin type A, or equivalent, are injected, beginning with 50 units per axilla through a 30-gauge needle in a grid-like pattern in spacing of 1 to 2 cm.  There does not appear to be a great deal of difference whether injections are done intradermally or subcutaneously; intradermal may be more painful but are probably more effective. Thus most give intradermally at 10 to 20 sites. Injections can be a bit painful. Freezing with either a cold spray or with ice cubes wrapped in gauze, or a cold pack, applied just prior to injection, is the easiest and probably most effective way of decreasing discomfort. Mixing the botulinum with local anaesthetic as opposed to normal saline doesn't seem to help much.

How much botulinum is needed for axillary hyperhidrosis? It is worth noting that in a randomized study of botulinum injection for hyperhidrosis, when the sweating gradually returned, patients described it as “close to as it has been before treatment” even though objectively it was below baseline.  Several have found that the 100 and 200 unit doses of Dysport were equally effective.

The average duration of effective botulinum is seven months for axillary treatment.