OnabotulinumtoxinA Injections (Botox®)

In 2004, the U.S. Food & Drug Administration (FDA) approved BOTOX (onabotulinumtoxinA) for the treatment of severe primary axillary hyperhidrosis (excessive sweating of the underarms) in patients unable to obtain relief using antiperspirants. BOTOX is owned by AbbVie, Inc., and it is the most studied brand of botulinum toxin in the world. BOTOX is approved to treat a total of eight medical conditions in the United States and received its first FDA approval in 1989. Over the years, it has been used to treat millions of patients with various conditions, including spasticity and movement disorders. At least 20 countries have approved BOTOX for the treatment of underarm excessive sweating. (For complete prescribing information for Botox for hyperhidrosis, click here.)

OnabotulinumtoxinA is a natural, purified protein with the ability to temporarily block the secretion of the chemical that is responsible for "turning on" the body's sweat glands. By blocking, or interrupting, this chemical messenger, botulinum toxin "turns off" sweating at the area where it has been injected. Botox injections are very shallow, meaning that the medicine is injected just below the surface of the skin, where it remains. 

Research demonstrates that treating excessive sweating of the armpits, hands, feet, head and face (craniofacial), and other relatively small body areas (like under the breasts) with onabotulinumtoxinA is safe and effective. When used to treat underarm excessive sweating, Botox has been shown to result in an 82-87% decrease in sweating. Results start to be noticeable approximately 2 to 4 days after treatment with the full effects usually noted within 2 weeks. Dryness typically lasts 4 to 12 months, but some studies have found it can last as long as 14 months. Additional statistics from published research studies have shown that repeated treatment with Botox is safe and effective for hyperhidrosis and consistently results in meaningful, long-lasting improvements in an excessive sweating patient’s symptoms, daily functioning, and quality of life. Botox treatment for hyperhidrosis has also been scientifically proven to improve on-the-job productivity. While sweating is an essential body function for temperature control, localized body areas house only a small percentage of the body's sweat glands (the underarms, for instance, are home to less than 2% of the body’s sweat glands.) The temporary cessation of these sweat glands' functioning, therefore, has little to do with body thermoregulation. Compensatory sweating (sweating on other body parts, common after ETS surgery) has not been found to be a concern.

In the case of palmar (hand) excessive sweating, research shows that Botox is 80-90% effective. Repeat injections are needed after 6 months. Botox for palmar sweating may cause temporary pain and weakness in the hands. 

Botox injections work well on the head and face, but the injection technique requires skill, so patients should seek an experienced practitionerA potential side effect of Botox injections in the face as a treatment for sweating is asymmetry, particularly of the forehead. This can happen if some of the Botox diffuses into the facial muscles. Such asymmetry, however, is always temporary and can, if necessary, be balanced out by additional Botox injections. 

Botox can also be used for plantar hyperhidrosis (excessive sweating of the feet), but patients report more pain during plantar injections and statistics indicate the treatment is less effective than when used for other body sites; indeed, some data suggests that 50% of patients are dissatisfied with the results. 

There are multiple forms of botulinum toxin-A on the market. Conversion ratios between the brandnames Botox (onabotulinum toxin-A), Dysport (abobotulinum toxin-A) and Xeomin (incobotulinum toxin A) in practice, according to an article in the journal toxins are: 

Botox and Xeomin - 1:1 (dose equivalent units)
Botox/Xeomin and Dysport - 1:2-3

According to the Cleveland Clinic, results may last longer and manifest faster with Xeomin and there may be fewer allergic reactions to Xeomin. Xeomin does not need to be refrigerated. Dysport may diffuse further or spread more. Effects of Dysport can last about the same as Botox but with Dysport effects visible at about 2 days compared to about 1 week with Botox. With all three injectables, FULL results will take a week or two to manifest. Of course results vary from individual to individual as well. Prices for the three injectables vary from practice to practice. Which botulinum toxin might be right for you? Weigh the pros and cons of each with your healthcare provider. 

Using Botox Injections Effectively

The use of Botox for the treatment of hyperhidrosis can be most effective when performed by a clinician who has received special training from the International Hyperhidrosis Society, and who has experience with the procedure. To find a clinician in your area who is familiar with hyperhidrosis treatments, use our Clinician Finder. Providers who have attended an International Hyperhidrosis Society educational event (which includes intensive, hands-on training on using Botox to treat hyperhidrosis) are designated as having been "IHhS Educated." 

Injections can be administered in a doctor's office, require relatively little time (very experienced medical professionals can inject both underarms in less than 10 minutes), and do not demand any restrictions in work or leisure activity (aside from refraining from intensive exercise or the use of a sauna on the day of the injections). Prior to Botox injections in the underarms, it’s best not to shave that area. Many healthcare professionals, in fact, prefer three to four days of hair growth prior to Botox injections. 

During the procedure, a very fine needle is used to inject tiny amounts of Botox just under the skin intermittently throughout the area of excessive sweating (in a grid pattern, approximately every 1 to 2 centimeters.) Multiple injections are given based on your care provider's assessment of the area that needs to be treated. To ease any potential discomfort, clinicians may use one or more of a number of anesthetic techniques such as nerve blocks, ice, or vibration analgesia. 

After you receive Botox injections for any focal area, it’s recommended that you follow up with your healthcare provider in 1 to 2 weeks. This follow-up is highly useful because it enables your clinician to ‘touch-up’ any sweating areas that may have been missed during the first round of injections and ensure that you are getting the treatment’s full benefit.

The cost of Botox treatments for hyperhidrosis will vary depending upon the size of the body area you need to be treated and whether insurance will cover any of the cost for you. A general estimate of the cost for two underarms is about $1,000. Botulinum toxin injections do not cure hyperhidrosis; your symptoms will go away gradually (usually in about a week) and return gradually. Follow-up injections are required to maintain dryness. These repeat injections may be necessary at intervals varying from 7 to 16 months.

Next Steps

Have you talked to your medical provider about excessive sweating? If not, now is the time! Learn more about how you and your healthcare team can work together to find the right treatment, or combination of treatments, to manage your hyperhidrosis.

Are you interested in trying local botulinum toxin injections for hyperhidrosis? As mentioned above, our Clinician Finder can help you locate medical providers who treat hyperhidrosis. Use it today!

Finally, you may want to consider participating in a clinical trial. Patients enrolled in clinical trials often receive treatments free of charge. Visit our Active Research page to find out more and whether you're eligible to participate in the latest studies.

And remember, because hyperhidrosis is a serious medical condition - you deserve insurance coverage and reimbursement for your medical visits and treatments, We've got tips to help you navigate the health insurance realm; visit Insurance Tools for more information. If you are seeking financial assistance for axillary hyperhidrosis treatment with Botox specifically, you may find help through the Botox assistance programs.

Research and References

Ready to learn more about Botox for the treatment of excessive sweating? Here are links to some relevant articles and abstracts published in medical journals:

Botulinum toxin for axillary hyperhidrosis

Botulinum neurotoxin treatment of palmar and plantar hyperhidrosis

Botulinum toxin for hyperhidrosis of areas other than the axillae and palms/soles

Treatment of palmar hyperhidrosis with needle-free injection of botulinum toxin A

Comparing Botox and Xeomin for axillary hyperhidrosis

Botulinum toxin: a treatment for compensatory hyperhidrosis in the trunk

Botulinum toxin for hyperhidrosis

Botulinum toxin type A versus topical 20% aluminum chloride for the treatment of moderate to severe primary focal axillary hyperhidrosis

Functional and dermatology-specific quality of life benefits with repeated botulinum toxin type A treatment of primary axillary hyperhidrosis over 4 years

Effect of botulinum toxin type A treatment for severe primary axillary hyperhidrosis on work performance and productivity: results from an open-label clinical study

Print   Email