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Hyperhidrosis :: BOTOX® |
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Hyperhidrosis (excessive sweating) is a troublesome condition that results in uncomfortable and awkward social situations for those who are affected by it. Many affected individuals must change their shirts or socks several times a day, or constantly wipe their hands self consciously. If you suffer from excessive sweating, you are not alone. It is estimated that several million people in the world are affected by hyperhidrosis (approximately one percent of the world population). 1
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Though topical medications, oral medications, iontophoresis, and surgery have not proven to be very effective in the majority of patients, botulinum toxin has been found to give effective temporary relieve from this embarrassing condition. Physicians inject botulinum toxin into the affected area in order to prevent the sweat glands from overproducing sweat. Sweat glands are stimulated by nerves that release a chemical called acetylcholine and cause sweat production. Botulinum toxin, when injected into the vicinity of the sweat glands, blocks the release of the acetylcholine, thereby temporarily reducing or abolishing sweat production.
Botulinum toxin type A, also known as BOTOX®, is made from a naturally occurring bacteria called Clostridium botulinum. Thought BOTOX® was approved by the FDA for its use in patients suffering from cervical dystonia (spasms of the neck), it is also currently being used effectively by physicians to treat facial wrinkles, migraines and excessive sweating. Because botulinum toxin is not FDA-approved for the treatment of excessive sweating, insurance companies may not cover the cost of this effective procedure.
BOTOX® 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 usually the only pain control necessary for the injections in the under arm. If the palms 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 feel 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, BOTOX® 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 BOTOX® in the clinical trials examining its use in cervical dystonia include dry mouth, muscle soreness, and dyspepsia (indigestion). These side effects are all temporary.
BOTOX®, 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.
1 The American Institute for Hyperhidrosis
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