Don't Sweat It. Botox Injections Help Keep Heavy Perspirers Dry

Medically Reviewed by Gary D. Vogin, MD
From the WebMD Archives

Feb. 14, 2001 -- Hanne Heilesen had suffered from excessive underarm sweating for more than half her life and had reluctantly decided to undergo surgery for the problem when her doctor told her about a treatment involving injections with a toxin associated with a deadly form of food poisoning.

"I was skeptical at first, but I really didn't want to have surgery, because I had read about complications," the 38-year-old woman from Brussels, Belgium, tells WebMD. "But I had to do something. I was beginning a new career in personal growth training, and I didn't want to be in front of people all day worrying about the sweat under my arms."

In mid-December, Heilesen had her first injections of botulinum toxin A, known as Botox in the U.S., now widely used by dermatologists to smooth facial wrinkles. She received 12 injections under each arm to temporarily paralyze her overactive sweat glands and now says that the treatment was an unqualified success.

"It has made all the difference. I used to have to change T-shirts two or three times a day and was always having to think about this," she says. "Even at my wedding, I had to have special pads made to match my dress to avoid having sweat marks. Now I can wear any kind of clothes without having to worry."

Although more and more dermatologists are using Botox for the treatment of excessive sweating, until now there have been no large studies proving its effectiveness. In the Feb. 15 issue of The NewEngland Journal of Medicine, researchers from Munich, Germany's Ludwig-Maximilians University report that the toxin was both safe and effective in the treatment of 145 patients with underarm hyperhidrosis. The vast majority of patients still had substantial reductions in underarm sweat six months after receiving treatment, and almost all (98%) said they would recommend the therapy to others.

About 1% of Americans have the condition known as hyperhidrosis, or excessive sweating. It can occur in the hands, armpits, feet, face, trunk, or a combination of locations, and usually begins during childhood or adolescence. While the cause remains something of a mystery, there appears to be a strong genetic component to excessive sweating, with about 70% of those seeking treatment reportedly having a close relative with the disorder.

Current treatments range from the simple -- the use of antiperspirants with aluminum chloride -- to the extreme -- the removal of underarm sweat glands. A relatively new and less invasive surgical technique known as endoscopic thoracic sympathectomy (ETS) is also gaining popularity but is still somewhat controversial. Though supporters of the procedure claim that its side effects are minimal, others say it can result in nerve damage and may have unacceptable side effects.

Those treated with Botox in the German study reported no long-lasting or serious side effects. The treatment was judged to be far more effective than any non-surgical technique now in use.

"Personally, I have used Botox in the treatment of dozens of patients with excessive sweating, and I have no doubt that it works," Harold Brody, MD, a clinical professor of dermatology at Emory University Medical School in Atlanta, tells WebMD. "This study does not really tell us anything that we didn't already know. But it is a large, multicenter study, and that is important for receiving FDA approval for this indication." Brody, who is also president of the American Society of Dermatologic Surgery, reviewed this study for WebMD.

"Many people with this condition don't really know that there are treatments out there for them," he said. "They think they have to live with this, but they do have options. Liposuction of the sweat glands is another treatment that can be performed on an outpatient basis and can be used in combination with botulinum toxin injections."

Patients treated with Botox injections generally have to be retreated within a year. Heilesen says she was told her treatment would last from five to eight months.

"I will definitely do it again," she says. "It is just such a relief to be able to speak in front of a room full of people without worrying. This problem definitely affects people's perceptions of you. If people see you have big sweat marks under your arms, they immediately think you are nervous even if you are not."