Hyperhidrosis Botulinum Toxin

Botulinum toxin injections for primary axillary hyperhidrosis (excessive underarm sweating) at MEDICOM Clinic Brno. The neurotoxin temporarily blocks acetylcholine signalling to eccrine sweat glands, reducing sweating by 80–90% for 6–12 months per treatment cycle.

Hyperhidrosis treatment with botulinum toxin at MEDICOM Clinic Brno is one of the most clinically validated applications of neuromodulators outside wrinkle relaxation. Primary focal hyperhidrosis — excessive sweating in defined areas (most commonly the axillae) unrelated to systemic disease or medication — affects approximately 3% of the population and significantly impairs quality of life, causing social anxiety, clothing damage, and professional embarrassment that topical antiperspirants consistently fail to control. Botulinum toxin type A inhibits the release of acetylcholine at the neuromuscular junction. While this mechanism is most widely known for its effect on striated muscle (wrinkle relaxation), the same neurotransmitter controls the eccrine sweat glands via cholinergic innervation. Injecting botulinum toxin intradermally at the axilla — rather than intramuscularly — allows the toxin to block sweat gland stimulation without affecting underlying muscle activity. The iodine-starch test (Minor's test) is used to map the hyperhidrotic zone prior to injection, identifying the precise area of maximal sweating activity. The mapped area is then divided into a grid and the toxin is administered as multiple small intradermal injections spaced approximately 1–2 cm apart across the entire zone. The axilla is a common site for both the standard and a topical anaesthetic approach to minimise patient discomfort during the multiple injection points. Clinical response begins within 2–7 days of treatment and reaches maximum effect at 2 weeks. Published data consistently show 80–90% reduction in sweating volume with a single treatment session. Duration of effect is 6–12 months, after which the treatment can be repeated without loss of efficacy. Unlike surgical sympathectomy (endoscopic thoracic sympathectomy), botulinum toxin treatment is fully reversible, carries no risk of compensatory hyperhidrosis, and requires no anaesthesia or recovery period.