Botox Treatment for Palmar and Plantar Hyperhidrosis

For people suffering from hyperhidrosis that affects their hands and feet, botulinum injections, or botox for short, can provide significant relief from symptoms. Botox injections work best for those who have primary focal hyperhidrosis.
Botox Treatment for Palmar and Plantar Hyperhidrosis

For people suffering from hyperhidrosis that affects their hands and feet, botulinum injections, or botox for short, can provide significant relief from symptoms. Botox injections work best for those who have primary focal hyperhidrosis (sweating in localized, specific areas). Although it is not approved by the FDA, botox as a treatment for sweaty hands and and as a treatment for sweaty feet can be highly effective. Recieving a localized treatment like Botox can be helpful for people who suffer from uncomfortable conditions on their extremities, like clammy hands and feet, as a result of hyperhidrosis. Sweat glands cover the entire body, but are especially prevalent on the palms of the hands and the soles of the feet. People with primary focal hyperhidrosis have normal sweat glands, in the same density as non-affected people, but their sweat glands are overactive in specific areas, which is one of the causes of excessive sweating. This is why a localized treatment like botox injections can be so helpful.[1]

Botulinum toxin is a type of neurotoxin produced by a bacteria called Clostridium botulinum which can cause paralysis in humans. In recent years, this toxin has been utilized in many medical treatments and has been found especially effective for managing the sweat caused by primary focal hyperhidrosis. Botox injections are effective in eliminating symptoms in all patients for the first two months, and results can remain effective in most patients after six months.[2] Botox is a viable treatment for those suffering from palmar and plantar hyperhidrosis who have not had success in managing hyperhidrosis at home, and in whom over the counter topical treatments, prescription antiperspirants, and iontophoresis have not been effective. This treatment is typically a second line option, and patients should work to find out if more conservative treatments are effective when managing hyperhidrosis with a doctor, and before initiating botox injections. It is common that first line treatments are not enough, and so botox injections are an excellent method for reducing symptoms and improving quality of life. Most patients who initiate treatment are motivated to stick with it due to its effectiveness and lack of adverse effects.[1] Currently, botox injections are used off-label for the treatment of palmar and plantar hyperhidrosis, but they are FDA approved for use in axillary hyperhidrosis.[4]

How Botox for Palmar and Plantar Hyperhidrosis Works

There are four brands of botox formulations that are approved for use in United States, and each one works slightly differently. When injected, all botulinum toxins block the release of acetylcholine and various other neurotransmitters which prevent the eccrine glands (sweat glands) from producing sweat and thus prevents perspiration. The injections are placed directly into the affected areas of the palms or soles.[1]

Before botox treatment is started, an iodine-starch test may be performed to determine the area of the palm or sole that requires treatment. A povidone-iodine solution is painted onto the area and then cornstarch is added. When the patient begins to sweat, the mixture highlights the moistened areas by forming dark marks where sweat is collecting, thereby letting the practitioner know where the problem areas are.[4] A grid is then marked on the hand or foot that is going to be treated, indicating where the injections will be placed.

Prior to beginning injections patients, are given some type of pain management. Typically, a regional nerve block is placed so that a patient will temporarily lose sensation of the palm or foot. This is done with an injection and blocks sensations from the local nerves. Other types of pain control are sometimes used, such as needle-free anesthesia, ice, skin-cooling devices, vibrational analgesia or pocketed microneedles.[1]

The botulinum is then injected into the skin of the palms or soles of the feet where the marks indicate. The skin of the palms and soles can be particularly thick so multiple needles may be used. The type of botulinum formula that is used is variable and depends on the doctor. Treatments usually need to be repeated once every six months.[1]

Adverse Effects

The most common side effect of palmar and plantar botulinum injections are immediate pain and bruising at the injection site. Injections in the palm can sometimes cause weakness in the muscles of the hand and atrophy of muscles. This can be fairly common. Other complications can arise from the regional nerve block and can include neuropathy, impaired hand dexterity and other potential issues.[1]

When Botox Should Not be Used

There are some situations in which botox injections should not be considered as a treatment option. Botox is considered a category C medication for pregnant women and so should be avoided during pregnancy and nursing. It is also important to make sure a patient is not allergic to botulinum toxin before treatment can be initiated. There are also certain medications that can impact the metabolism of botulinum and make it unsafe to use. Botox is generally not recommended as a medical treatment for children with hyperhidrosis.[1]

For those who are struggling to find successful treatment for sweaty hands or treatment for sweaty feet, botulinum injections may be the right next step in their journey to conquering hyperhidrosis. It is less invasive than surgical treatments for primary focal hyperhidrosis and has been shown to be very effective treatment modality. Unfortunately, botox injections can be expensive and add to the exorbitant cost of hyperhidrosis.

  1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Amsterdam: Elsevier Pub. Co., 2014. Retrieved
  2. Saadia, D., Voustianiouk, A., Wang, A. K., & Kaufman, H. (2001). Botulinum toxin type A in primary palmar hyperhidrosis Randomized, single-blind, two-dose study. Neurology, 57(11). doi:
  3. Doft, M. A., Hardy, K. L., & Ascherman, J. A. (2012). Treatment of Hyperhidrosis with Botulinum Toxin. Aesthetic Surgery Journal, 32(2), 238-244. Retrieved July 29, 2018, from
  4. Walling, H. W., & Swick, B. L. (2011). Treatment Options for Hyperhidrosis. American Journal of Clinical Dermatology, 12(5), 285-295. Retrieved July 27, 2018, from
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