Botulinum Toxin Hyperhidrosis Precare Information

This page provides important information about your proposed botulinum toxin treatment for excessive sweating, including how it works, what you may expect, how to prepare and the potential benefits, limitations and risks. Please read it carefully before your appointment and contact us if you have any questions.

What is hyperhidrosis?

Hyperhidrosis means excessive sweating beyond what is normally required to regulate body temperature. It can affect areas including:

• the underarms (axillae);
• the palms;
• the soles;
• the face or scalp; and
• other localised areas.

Botulinum toxin may be considered when excessive sweating is causing significant practical, occupational, social or emotional difficulty and other treatments have not provided sufficient improvement or have not been suitable.

Botulinum toxin reduces sweating but does not treat an underlying medical cause. Excessive sweating may sometimes be related to a medical condition or medication. Your doctor will consider whether any further assessment or investigation is appropriate before recommending treatment.

Product licensing and off-label treatment

Botulinum toxin type A is a prescription-only medicine. BOTOX® is licensed in the UK for the management of severe hyperhidrosis of the underarms that has not responded to topical treatment with antiperspirants or antihidrotics. The use of BOCOUTURE® or another botulinum toxin product for hyperhidrosis is off-label. Treatment of the palms, soles, face, scalp or other non-axillary areas is also off-label, including when BOTOX® is used.

Off-label treatment means that an authorised medicine is being used for an indication or treatment area not specifically included in its UK marketing authorisation. Off-label treatment is established in medical practice in appropriately selected patients. Your doctor will explain which product is being recommended, whether your proposed treatment is licensed or off-label and why it is considered appropriate for you.

How does it work?

Botulinum toxin temporarily blocks the nerve signals that stimulate sweat glands. Small amounts are injected into the skin at multiple points across the area of excessive sweating.

The aim is to reduce excessive sweating. Treatment may not stop sweating completely, and untreated parts of the area may continue to sweat. Some areas may respond better than others, and improvement cannot be guaranteed.

What happens during treatment?

The treatment area will be assessed and marked. In some cases, a test may be performed on the skin to help identify the areas of greatest sweating.

Small amounts of botulinum toxin will then be injected into the skin at multiple points using a fine needle.

Most patients find treatment of the underarms manageable, although brief stinging or discomfort can occur at each injection point. Treatment of the palms and soles can be more uncomfortable because these areas are particularly sensitive. A topical anaesthetic or another method of pain relief may be offered where appropriate.

What are the possible benefits and limitations?

Botulinum toxin can substantially reduce sweating in the treated area and may improve comfort, confidence and day-to-day activities.

However:

• improvement cannot be guaranteed;
• sweating may not be reduced evenly or completely;
• untreated areas will continue to sweat;
• some treatment sites may respond better than others;
• the duration of benefit varies;
• repeat treatments are usually required to maintain the improvement;
• sweating may increase in another area; and
• treatment may become less effective over time, including because of the possible development of antibodies to botulinum toxin.

What are the possible side effects and risks?

Botulinum toxin has an established safety profile, but all medical treatments carry potential risks and side effects. Your doctor will assess your suitability and discuss any risks of particular relevance to the proposed treatment area and your individual circumstances.

Expected injection-site effects

Temporary effects at the injection sites may include:

• pain, stinging or tenderness;
• redness, swelling or small raised marks;
• minor bleeding or bruising;
• irritation or itching;
• altered sensation; and
• temporary discomfort in the treated area.

These effects are usually short-lived, although bruising can take several days to settle. Treatment of the palms and soles may cause more significant temporary discomfort.

Other possible temporary effects

Other reported effects include:

• headache;
• hot flushes;
• nausea;
• tiredness or flu-like symptoms;
• pain in the treated limb;
• temporary skin discolouration, particularly in darker skin types;
• temporary altered skin odour;
• a small lump beneath the skin;
• localised hair loss; and
• infection at an injection site.

Post-inflammatory pigmentation may occasionally develop following an injection, particularly in darker skin types.

Increased sweating may develop in areas that have not been treated. Following underarm treatment, this has been reported elsewhere on the body and is usually temporary, although it may persist.

Unwanted weakening of nearby muscles

Botulinum toxin may sometimes affect nearby muscles as well as the intended sweat glands, even when treatment has been administered correctly. The possible effect depends on the treatment site.

This may include:

• Underarms: temporary weakness, aching or discomfort affecting an arm or shoulder.
• Palms: temporary weakness of the hands or fingers, reduced grip strength, impaired dexterity or difficulty performing fine hand movements.
• Soles: temporary weakness of the feet or toes, discomfort when walking, or an effect on balance or gait.
• Face, scalp or another area: temporary weakness or altered movement of nearby muscles, which may cause asymmetry or interfere with the normal function of the area treated.

These effects are usually temporary and should gradually improve as the action of the botulinum toxin wears off, although this may take several weeks and occasionally longer.

Please tell your doctor before treatment about any occupation, sport, caring responsibility or other activity in which temporary weakness of the proposed treatment area could present a particular difficulty or safety risk. This is especially important if you rely on hand strength or dexterity for your work or other essential activities.

Allergic reactions

Allergic reactions to botulinum toxin or to another product used during the procedure are uncommon but possible. If a topical anaesthetic has been used, an allergic reaction to this may also occur.

Call 999 or seek immediate medical attention if you develop symptoms of a severe allergic reaction, such as difficulty breathing, swelling of the face, lips, mouth or throat, widespread hives, wheezing or feeling faint.

Rare spread of toxin effect and iatrogenic botulism

In rare cases, the effects of botulinum toxin can spread beyond the area treated and cause excessive or generalised muscle weakness or a serious condition called iatrogenic botulism. Symptoms may develop hours to weeks after treatment.

Warning signs include:

• difficulty breathing or shortness of breath;
• difficulty swallowing;
• coughing or choking when swallowing;
• slurred speech or other difficulty speaking;
• severe or unusual drooping of the upper eyelids;
• double or blurred vision; or
• facial or generalised muscle weakness.

These symptoms constitute a medical emergency. If you develop any of them following treatment, call 999 or attend your nearest A&E immediately. Do not wait for a response from the clinic before seeking emergency medical attention. Please notify the clinic once urgent medical help has been arranged.

How quickly does it work?

The effects are not immediate. Improvement commonly begins within approximately 3–7 days but may take 2–3 weeks to develop fully.

Please allow up to 3 weeks before assessing the final response, unless you have a clinical concern that requires earlier review.

How long does it last?

Following underarm treatment, the effect commonly lasts approximately 4–7 months and may sometimes last longer. Results following treatment of the palms, soles or other sites may be shorter or otherwise differ.

The effect wears off gradually, and repeat treatment may be required to maintain the improvement. The timing of any further treatment will be decided with your doctor according to the product used, the site treated and your individual response.

Suitability for treatment

Please tell your doctor before your appointment if any of the following apply, as treatment may need to be postponed, modified or avoided:

• You are pregnant, breastfeeding, trying to conceive or think that you may be pregnant.
• You have a neurological or neuromuscular condition, such as Bell’s palsy, myasthenia gravis, Lambert–Eaton syndrome or motor neurone disease.
• You have previously experienced aspiration/ aspiration pneumonia or had an adverse reaction or unexpected response to botulinum toxin, including difficulty swallowing, speaking or breathing.
• You have weakness affecting your hands, grip, arms, feet, balance or walking if treatment of the palms, underarms or soles is planned.
• You have an infection, inflammation, rash or another active skin condition in or close to the proposed treatment area.
• You are unwell on the day of treatment, including with a significant cough, cold, flu-like illness or fever.
• You have a bleeding or bruising disorder.
• You are taking anticoagulant or antiplatelet medication, such as warfarin, rivaroxaban, apixaban, clopidogrel or aspirin.
• You are taking medication that may interact with botulinum toxin, including certain antibiotics such as aminoglycosides or clindamycin, or medicines that affect muscle or nerve function.
• You have recently received, or are planning to receive, another botulinum toxin treatment.
• You are due to have surgery or have recently undergone another procedure in or close to the proposed treatment area.
• You have a history of severe allergy or anaphylaxis.
• You have previously experienced a reaction to a topical or local anaesthetic.
• Your sweating is new, has changed significantly, occurs predominantly at night or is associated with other unexplained symptoms.

Please tell your doctor about all medication and supplements you take and about any change in your health, medication or pregnancy status before treatment. Do not stop prescribed anticoagulant or antiplatelet medication unless the clinician responsible for prescribing it has specifically advised you to do so.

What are the alternatives?

Depending on the area affected and your individual circumstances, alternatives may include:

• clinical-strength topical antiperspirants or antihidrotics;
• prescription topical or oral medication;
• iontophoresis;
• device-based treatment;
• referral to another specialist;
• surgery in selected cases; or
• choosing not to proceed with treatment.

Your doctor can discuss the options that may be appropriate for you.

How should I prepare for my appointment?

Please:

• arrive with clean, dry skin in the area to be treated;
• do not apply deodorant, antiperspirant, moisturiser or other skincare products to the treatment area on the day of your appointment;
• avoid shaving or waxing the treatment area on the day of treatment, as this may irritate the skin;
• avoid alcohol on the day of treatment;
• wear loose, comfortable clothing that allows the treatment area to be accessed easily;
• tell your doctor about any change in your health, medication or pregnancy status since booking; and
• let the clinic know in advance if you are particularly concerned about discomfort or if treatment of the palms or soles is planned, so that pain-relief options can be discussed.

What should I expect after treatment?

You will be given written aftercare advice following your appointment. You will generally be advised to:

• avoid rubbing, massaging or applying firm pressure to the treated area for the remainder of the day;
• avoid vigorous exercise, swimming, steam rooms, saunas and other sources of significant heat for at least 48 hours, but ideally one week if possible;
• keep the treated area clean and avoid applying potentially irritating products until any redness or sensitivity has settled;
• avoid shaving or waxing the treated area until any irritation has resolved; and
• contact the clinic promptly if you experience an unexpected or concerning reaction.

If you have treatment of the palms or soles, take particular care with driving, operating machinery, exercise or other activities requiring secure grip, dexterity, balance or stable walking until you know whether any temporary weakness has occurred.

If you have any questions after reading this information, please contact us before your appointment.