Botulinum Toxin for Hyperhidrosis (Excessive Sweating)

Botulinum toxin injection for hyperhidrosis at DermaEsthetic temporarily blocks the neural signals to sweat glands, dramatically reducing or eliminating excessive sweating in the armpits, palms, soles and forehead. Unlike antiperspirants or topical treatments, which work at the skin surface, botulinum toxin acts directly on the acetylcholine release at the neuromuscular junction supplying eccrine sweat glands — providing a clean, reliable result that lasts three to six months. MUDr. Hana Šulcová has specialist experience in hyperhidrosis treatment and tailors the injection grid and dosage to the area and sweat severity identified at assessment.

Primary focal hyperhidrosis — excessive sweating localised to the armpits, palms, soles or forehead — affects an estimated 1–2% of the population and frequently causes significant social and professional distress. The condition results from overactive eccrine sweat glands controlled by the sympathetic nervous system via acetylcholine-releasing nerve terminals. Botulinum toxin injected precisely into the affected zone blocks acetylcholine release at these terminals, preventing the glands from receiving the signal to produce sweat. The glands themselves are unharmed; the blockade is temporary and wears off as the nerve terminals regenerate over three to six months. At DermaEsthetic MUDr. Hana Šulcová begins each session with a Minor's iodine–starch test (sweat mapping) to visualise the active sweat zones when indicated, then marks an injection grid over the treatment area. For the armpits, a standard grid spacing of approximately 1–2 cm is used across the hair-bearing zone; for the palms and soles — areas with significantly denser innervation — the grid is finer and local anaesthesia is offered as an optional extra to manage discomfort (the palmar nerves are superficial and the injections more sensitive than axillary ones). For the forehead, the injection pattern is adjusted to avoid brow ptosis. The treatment session typically takes 30–45 minutes depending on the area and grid density. Results begin within three to five days as the toxin takes effect, reaching maximal dryness by two weeks. Efficacy lasts three to six months; with repeated treatments some patients find the interval extends as the chronic sweat gland hyperstimulation subsides. MUDr. Šulcová recommends a follow-up at two weeks to assess coverage and administer any touch-up injections in undertreated zones. Botulinum toxin for hyperhidrosis is very well tolerated with a long safety record in this indication. The only sweat redistribution reported is minor and transient. Contraindications include certain neuromuscular disorders (myasthenia gravis), pregnancy and breastfeeding, and concurrent use of aminoglycoside antibiotics. Patients should shave the axillary area 12 hours before axillary treatment and avoid deodorants or antiperspirants on the day of the session.