A disorder where the sweat glands become overactive is called hyperhidrosis, also known as excessive sweating. The result is excessive sweating that is not associated with exercise, temperature or any other common factors. The soles of the feet, armpits, and palms of the hands are among the body parts that are frequently impacted.

The estimated prevalence ranges from 1 to 5% of the population. This generally doesn't pose a major health risk to people. But it can also affect quality of life and be inconvenient and embarrassing.

Secondary hyperhidrosis is the medical term for excessive sweating that has a recognized cause, such as menopause, Parkinson's disease, low blood sugar, or an overactive thyroid gland. Primary hyperhidrosis is the term for it when it appears without a known reason.

The sympathetic nervous system, which regulates the body's fight-or-flight response and serves as its thermostat, is believed that it plays an important role in excessive sweating. Genetics might also be a key. When a person has primary hyperhidrosis, it appears that the brain activates the sweat glands in the absence of the conditions that would call for sweat to act as a cooling agent.

Using Botox to treat excessive sweating from the armpit has been FDA-approved.  However, doctors also use Botox as an “Off-label use” to reduce sweating in other areas, such as the hands, feet and face.

What is “off-label” use?

A drug or therapy used for a condition or purpose that has not been officially approved by regulatory authorities is referred as "off-label" use. It means using a medication or treatment in a way that is not stated by its label or package insert. Doctors may prescribe drugs off-label based on their clinical judgment and professional knowledge. Off-label use is legal and common, but its risks and benefits should be carefully considered.

According to the International Hyperhidrosis Society, patients who receive injections of botulinum toxin treatment have noticed a >85% reduction in excessive sweating. The injection site may experience bruising, swelling, and pain as a result of the injection.

Injections can be administered in a clinic, require a relatively short time in less than 30 minutes duration, and do not require limitations in activity (aside from avoiding from intensive exercise or sauna on the day of treatment). It's suggested not to shaving that area before getting treatment in the underarms.

During the procedure, tiny amounts of botulinum toxin are intermittently injected beneath skin throughout the area of excessive sweating (in a grid pattern, roughly every 1 to 2 cm). There are multiple injections delivered. The doctor might apply vibration analgesia or use ice to ease any potential discomfort.

Acetylcholine, a neurotransmitter in charge of stimulating sweat glands, is prevented from releasing by botulinum toxin. When your body temperature rises, your neurological system often causes your sweat glands to become active. Your body naturally cools itself in this way. However, the neurons that alert the sweat glands are overactive in persons with hyperhidrosis. The activity of the sweat glands is decreased by injecting botulinum toxin into the troubled locations, which reduces sweating. The effects are localized and temporary, generally lasting for several months.

Pros

• Minimal invasive treatment
• When administered under the armpits, the pain is nearly nonexistent.
• Relatively risk-free procedure
• Effective results. A study [i]shows that 90 percent decrease in sweat production 2 weeks after the procedure

[i] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781989/

Cons

• Compared to the armpit, the palms or soles of the feet would be more painful to inject.
• Temporary solution: Botulinum toxin is a temporary treatment as the patient needs follow-up injections every few months to one year (depending on the person's conditions), unlike surgery that removes the sweat gland.
• FDA approved for armpits only at this stage.
• Potential side effects: despite being very safe, Botulinum toxin injections may have negative outcomes. A few of these include temporary muscle weakness, pain or bruising at the injection site, and in very uncommon circumstances, allergic reactions. However, side effects are typically temporary and resolve on their own.

The human body possesses millions of sweat glands. An average person is estimated to have between three to four million sweat glands. Small area of sweat glands won't interfere with the ability to regulate body temperature.

It is always recommended to consult with a licensed doctor to find out how to address your issue.  In Marina Medical, we will go through a comprehensive clinical evaluation. Assessing the level of hyperhidrosis, discover how it affects the patient's quality of life, and ruling out any underlying medical issues that might be causing secondary hyperhidrosis are the goals. Doctors will also take patient's preferences, therapeutic objectives, and expectations into account.