Botulinum Toxin — Hyperhidrosis (Excessive Sweating)

For patients experiencing problematic excessive sweating — hyperhidrosis — that fails to respond to prescription-strength antiperspirants, botulinum toxin injection offers a well-established, reversible solution. MarBelle Clinic uses Dysport injected in a grid pattern across the affected area to temporarily block the cholinergic nerve signals to eccrine sweat glands, reducing sweat production by 80–90% for six to nine months. Treatment is available for the underarms, palms, and soles of the feet — the three most commonly affected sites in primary focal hyperhidrosis.

Primary focal hyperhidrosis is a condition affecting approximately 2–3% of the population, producing sweating that is disproportionate to thermoregulatory needs. For those affected, it has significant quality-of-life consequences — social anxiety, wardrobe limitations, occupational impact, and skin maceration and infection risks. When topical treatments (including aluminium chloride hexahydrate) fail or cause skin irritation, botulinum toxin injection is the recommended next-line treatment and has a well-supported evidence base across multiple decades of clinical use. The mechanism differs from its aesthetic application: rather than blocking the somatic motor nerve signal to skeletal muscle, hyperhidrosis treatment blocks the sympathetic cholinergic innervation of eccrine sweat glands. These glands, which produce watery eccrine sweat in response to temperature and emotional stimuli, become temporarily non-responsive to their nerve signal and stop secreting. At MarBelle Clinic, the procedure is performed using Dysport — a botulinum toxin A formulation with established data for hyperhidrosis treatment. The injection protocol involves mapping the treatment area and placing injections in a regular grid, typically 1–2 cm apart, to ensure even coverage of the gland field. For underarms, this involves approximately 15–20 injection points per side; for palms and soles, the grid covers the entire glandular zone of the hand or foot. The underarm treatment is well tolerated — mildly uncomfortable at most. Palm and sole treatments are more sensitive due to the higher density of nerve endings and thin skin, and topical numbing cream or ice application is used beforehand. Results onset within four to seven days and are typically maximum at two weeks — sweating in the treated area reduces dramatically, with many patients reporting complete resolution. The effect lasts six to nine months, at which point the treatment can be repeated without loss of efficacy over repeated cycles. There is no systemic effect on sweating — the body compensates only negligibly, if at all, because the total skin area treated represents a small fraction of the body's overall sweat gland surface area.