Botulinum Injections

Botulinum toxin injection is overall the most effective nonsurgical therapy for focal hyperhidrosis.  Therapeutic failure from antibody formation is theoretically possible, but unlike the circumstance of its use for dystonia where large amounts are administered, this appears to be very rare with hyperhidrosis.

An easy way of identifying areas of sweat is a simple facial tissue and a gentian violet, starch or iodine marker. Hot spots producing greater amounts of sweat can then be identified and higher doses are applied there.  The typical area of treatment corresponds to the hairy area.  Generally, all that is needed for analgesia is an ice pack applied to the axillae prior to injection.