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Myobloc™ for Hyperhidrosis
Treatment of Hyperhidrosis with Myobloc™
Hyperhidrosis is a troublesome problem that results in awkward social situations for those that are affected by it. Many affected individuals must change their shirts or socks several times a day, or wipe their hands self consciously on multiple occasions. Unfortunately, topical and oral medications, iontophoresis, and surgery have not proven to be very effective in the majority of people. It is known that he glands are innervated by sympathetic nerves that use acetylcholine as the neurotransmitter necessary to cause sweat production. Botulinum toxin, when injected into the vicinity of the sweat glands, is effective in temporarily reducing or abolishing sweat production.
Botulinum toxin Type B, also known as Myobloc™, is FDA approved for its use in cervical dystonia (spasms of the neck). Is also used for the treatment of facial wrinkles, migraines and excessive sweating, although it is not FDA approved for this purpose. Because it is not FDA approved for the treatment of excessive sweating, insurance companies do not cover the cost of this effective procedure.
Botulinum toxin Type B (Myobloc™) is made from a naturally occurring bacteria called Clostridium botulinum. Myobloc™ can be safely injected directly in a specific area to temporarily cause decreased sweating in that area. Although Myobloc™ is FDA approved for its use in cervical dystonia (spasms of the neck), it has also been used "off-label" for wrinkles, migraines and excessive sweating (also known as hyperhidrosis). Myobloc™ is currently used in our office to decrease sweating in the underarms (axillae), palms (hands), and soles (feet).
Prior to the injections, a topical anesthetic (EMLA 0r ELA-Max) is placed on the skin and covered with plastic. The cream is left in place for 20 - 30 minutes to numb the skin prior to the injections. The topical anesthetic is all of the pain control necessary for the injections in the under arm. If the plams and soles are to be injected, the physician may choose to perform a nerve block that numbs the entire hand or foot. These nerve blocks consist of 3-4 injections per hand or foot using a small needle. After the injection, the treated hand or foot will fell numb for 30 minutes to one hour. You are advised not to drive for 2 hours after having these anesthetic injections because they may interfere with your ability to drive.
After the area to be treated has been numbed with topical cream or the injections, Myobloc™ injections are performed in the area to be treated. The needle that is used is a 30 gauge needle which is the same size as an acupuncture needle. Approximately 40 injections will be performed in each hand or foot or 20 injections per underarm.
After the injections, the skin may appear slightly bruised, and the skin will feel numb from the anesthesia. After 2 hours, normal activities can be resumed including exercise. In approximately 48 hours after the injections, a decrease of sweating in the treated areas will be noted. This effect lasts for 4 months in most individuals.
The most common side effect of this procedure is bruising and mild soreness in the treated areas. Because this treatment is also used to relax muscles, it is possible to develop decreased muscle strength in the treated areas. This is most often noticeable in the hands and is most bothersome to tennis players, piano players, and others who rely on good muscle strength in the hands. Although this side effect is not common, it does occur and may last for four months in some individuals. Other side effects associated with the same dose of Myobloc™ in the clinical trials examining its use in cervical dystonia include dry mouth, muscle soreness, and dyspepsia (indigestion). This side effects are all temporary.
Myobloc™, when used by an experienced physician, is a safe and effective way to eliminate the embarrassing problem of excessive sweating of the underarms, hands and feet. For more information, please feel free to discuss this with any member of our office staff.
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