Hyperhidrosis Treatment — Excessive Sweating

Hyperhidrosis (excessive sweating) treatment at Brandeis Clinic uses botulinum toxin type A injections to block the nerve signals that activate eccrine sweat glands in the affected area. MUDr. Lucie Kalinová injects small amounts of botulinum toxin across the treatment zone — most commonly the underarms, but also palms and soles of feet — in a session lasting approximately 10 minutes per area. Results begin in 2–10 days and last 8–12 months on average, substantially longer than the 4–6 months typical of cosmetic facial applications. The procedure requires no anaesthesia for underarm treatment and is performed as an outpatient appointment.

Hyperhidrosis treatment with botulinum toxin at Brandeis Clinic addresses a condition that significantly affects quality of life — primary focal hyperhidrosis, defined as excessive sweating that exceeds the body's thermoregulatory needs and is not caused by systemic disease or medication. **Mechanism of action:** Sweat glands are innervated by sympathetic cholinergic nerve fibres — unlike most of the sympathetic nervous system, which uses adrenaline, the sweat gland innervation uses acetylcholine. Botulinum toxin blocks acetylcholine release at these nerve terminals in exactly the same way it blocks neuromuscular junctions in cosmetic applications. The result is a localised, selective suppression of sweat gland output that persists until the nerve terminal regenerates. **Why hyperhidrosis botulinum toxin lasts longer than cosmetic use:** The longer duration (8–12 months vs 4–6 months for forehead or crow's feet) is not a different product — it is a function of the anatomy and activity level of the nerves being blocked. Facial expressive muscles are activated hundreds of times per day; sweat gland nerves fire episodically rather than continuously. Lower firing frequency slows the regeneration stimulus, extending the effective duration of the block. **Areas treated:** *Underarms (axillae) — most common (from 10,500 Kč):* The treatment area is mapped using a Minor's starch-iodine test if needed (iodine applied to dry skin, starch powder applied on top — active sweat zones turn dark blue, defining the injection grid). Botulinum toxin is injected superficially in a grid pattern 1–2cm apart across the entire hyperhidrotic zone. No anaesthesia is typically needed as the skin is not particularly sensitive in this area. The 10-minute session produces profound reduction in underarm sweating in the large majority of treated patients. *Palms:* Palmar hyperhidrosis — excessive hand sweating — can have significant occupational and social consequences. The palmar skin is significantly denser and more pain-sensitive than axillary skin; patients may benefit from the application of topical anaesthetic cream or ice before injection. Multiple injection points across the palm are required. *Soles of feet:* The least commonly treated area due to the plantar skin's thickness and sensitivity, but botulinum toxin is effective. Ice or topical anaesthetic is typically used. **Post-treatment instructions:** Avoid touching or massaging the treated area immediately after. No cosmetics or deodorants for 24 hours. Wait 72 hours before shaving the underarm (to allow micro-injection sites to close). Minor redness or pinpoint swelling resolves quickly. **Results:** Onset begins 2–10 days after treatment as the botulinum toxin progressively blocks nerve terminals. Full effect is usually established at 2 weeks. Sweating is markedly reduced — most patients experience near-complete cessation in the treated zone. Individual variation exists; patients with very high sweat output may experience partial rather than complete suppression, which is still functionally significant. **Contraindications:** Pregnant or nursing women. Neuromuscular disorders. Active skin infection over the treatment area.