Botulotoxin — Hyperhidrosis (Excessive Sweating) Treatment

Specialist botulotoxin treatment for primary hyperhidrosis — excessive uncontrollable sweating of the underarms, palms or soles — at CLED. Before injection MUDr. Moskalyková performs a Minor iodine-starch test that visibly identifies exactly which sweat glands are active, allowing each injection to be placed with precision over confirmed active zones rather than following a standard grid. Effect onset is within 24 hours; duration ranges from 4 months (palms) to 12 months (underarms). The same botulotoxin product is used for facial treatment and hyperhidrosis, ensuring consistency of supply and dosing.

Primary hyperhidrosis is a condition of excessive sweating beyond what is needed for thermoregulation — affecting approximately 1–3% of the population — and is driven by overactivity of the eccrine sweat glands under neural stimulation. The underarms, palms and soles are the most commonly affected zones. Social and professional impact is significant: many patients avoid certain fabrics, avoid handshakes or limit social activities because of the condition. Topical antiperspirants and oral medications are frequently inadequate. Botulotoxin — the same agent used for wrinkle relaxation — works for hyperhidrosis through a different but parallel mechanism: rather than blocking neuromuscular signalling to a skeletal muscle, it blocks the cholinergic nerve fibres that innervate eccrine sweat glands, preventing the neural trigger that initiates sweating. When injected across an active sweating zone, botulotoxin substantially reduces sweat output in those glands for the duration of its effect. The clinical advantage of the approach at CLED is the pre-injection mapping step. The Minor iodine-starch test — also called the Minor sweating test — is a validated dermatological procedure: iodine solution is painted over the dry skin of the treatment zone and allowed to dry, then starch powder is dusted over it. Wherever active sweat reaches the surface, it dissolves the starch granules and reacts with the iodine to produce a deep blue-purple colour. The resulting map is photographed and marked before injection, ensuring MUDr. Moskalyková injects precisely at each active gland cluster rather than following a generic pattern. This targeted approach reduces the total product dose needed and ensures no active zones are missed. Injection of the underarm zone uses a fine needle in a series of intradermal points spaced approximately 1 cm apart across the identified active zone. Local anaesthetic cream is applied beforehand for underarm treatment; for palmar treatment, more complete anaesthesia (nerve block or ice) is used given the high sensitivity of the palms. Sessions for the underarms take 10–20 minutes, palms or soles slightly longer. Effect onset is earlier than for muscular botulotoxin: typically within 24 hours for hyperhidrosis, with maximum reduction evident by three to seven days. Duration is site-dependent: underarms typically 6–12 months, palms 4–6 months, soles up to 12 months. Retreatment is straightforward and the mapping test is repeated before each session.