Can Botulinum Toxin Have An Effect For Hyperhidrosis?

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Pertinent Pointers On Ensuring The Correct Dosage

Here is a list of approximate relative potencies of different brands of botulinum toxin A:

1-unit Botox ≈
1-3 units Dysport ≈
50-100 units Myobloc

This is only a rough guide and it probably varies with the use (cosmetic, hyperhidrosis, medical). The median lethal dose (LD-50) estimate in humans is about 3,000 units of Botox. Typical cosmetic use is 30 to 100 Botox units. Typical hyperhidrosis use is 50 to 200 units. Medical uses can be considerably higher.
Aminoglycoside antibiotics may potentiate the effects of botulinum toxin so one should reduce the toxin dose. If using toxin in a patient with neuromuscular disease, reduce the dosage and be very conservative.
Do not use botulinum toxin in women who are pregnant, those who could
be pregnant or lactating women. When one accidentally or intentionally uses botulinum toxin in pregnant women,
complications are rare and may not be related to the BTX-A.29-31 (Intentional use at high doses may be for significant medical problems.)
If a birth defect should occur, even if the relationship between cause and effect is unlikely, process servers might appear at your door.

Suzanne M. Levine, RPT, DPM, and Everett M. Lautin, MD, FACR

24. Gregoriou S, Rigopoulos D, Makris M, Liakou A, Agiosofitou E, Stefanaki C, Kontochristopoulos G. Effects of botulinum toxin-a therapy for palmar hyperhidrosis in plantar sweat production. Dermatol Surg. 2010; 36(4):496-498.
25. Lowe N, Campanati A, Bodokh I, Cliff S, Jaen P, Kreyden O, Naumann M, Offidani A, Vadoud J, Hamm H. The place of botulinum toxin type A in the treatment of focal hyperhidrosis. Br J Dermatol. 2004; 151(6):1115-1122.
26. Glogau RG. Topically applied botulinum toxin type A for the treatment of primary axillary hyperhidrosis: results of a randomized, blinded, vehicle-controlled study. Dermatol Surg. 2007; 33(1 Spec No.):S76-80.
27. Smith KC, Comite SL, Storwick GS. Ice minimizes discomfort associated with injection of botulinum toxin type A for the treatment of palmar and plantar hyperhidrosis. Dermatol Surg; 2007; 33(1 Spec No.):S88-91.
28. Richards RN. Ethyl chloride spray for sensory relief for botulinum toxin injections of the hands and feet. J Cutan Med Surg. 2009; 13(5):253-256.
29. Li Yim JFT, Weir CR. Botulinum toxin and pregnancy-a cautionary tale. Strabismus. 2010; 18(2):65-66.
30. El-Sayed YY, Caughey AB. Medical treatment for pregnant women: balancing risks and benefits. J Perinatol. 2009; 29(9):589-590.
31. Wataganara T, Leelakusolvong S, Sunsaneevithayakul P, Vantanasiri C. Treatment of severe achalasia during pregnancy with esophagoscopic injection of botulinum toxin A: a case report. J Perinatol. 2009; 29(9):637-639.
32. Howl J, Jones S. Transport molecules using reverse sequence HIV-Tat polypeptides: not just any old Tat? (WO200808225). Expert Opin Ther Pat. 2009; 19(9):1329-1333.

   Editor’s note: For those interested in training for botulinum toxin injections, the authors suggest the Web site of the IAFS ( ) as a possible resource.

   For further reading, see “What You Should Know About Managing Hyperhidrosis” in the October 2004 issue of Podiatry Today.

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