The Treatment with Botulinum Toxin (BOTOX® / Dysport)

Although it is unpleasant, Hyperhidrosis is a benign problem. Therefore any procedure that involves disproportionate risks to the problem should be discarded as a treatment form. In recent years, the use of Botulinum Toxin has begun to be dominated. This treatment has been safely used and it can be applied for a wide variety of indications, among them, the control of Hyperhidrosis. The Botulinum Toxin seems to be a safe and simple alternative for the control of the excessive sweating.
In outbreaks of Botulismo B that happened in Switzerland, it was observed that the Botulinum Toxin, besides the blocking action in the striated musculature, it also blocked the neuro transmission of the autonomous nervous system. There were patients with Botulism that presented sweating suppression that lasted up to 2 years .

The first report of sweating suppression using the pharmacological Botulinum Toxin was made in a study in 1995. At that time, a volunteer doctor injected in himself 1 unit of Botulinum Toxin in the subcutaneous of the forearm. As a result, the sweating of this region was decreased.
Nowadays, the Botulinum Toxin has been used to control the palmar and axillary Hyperhidrosis and even the Hyperhidrosis of other parts of the body. The time of action varies from 4 to 12 months, depending on the case and on area of the injections. The effects aren’t definitive, but the repeated injections may be used, showing great results in the immense majority of the cases.

Botulinum Toxin used for therapeutical situations is increasing, and the indications reach wide areas of medicine. It is used in neuromuscular dystonia, in aesthetic treatments, in oftalmologic problems, for Frey’ s Syndrome, muscular spasms, and an indication that promises to be very positive, the tensional migraine. Frequently, patients who are submitted to the Botulinum Toxin treatment for aesthetic control of the forehead wrinkles, refer to the improvement of chronic tensional migraine. It is not hard to find patients who regularly use the Botulinum Toxin to control wrinkles requesting the re-injections because of the improvement they obtained in chronic tensional migraine they previously suffered from.

Although several vascular surgeons who are part of our group are used to the technique of the Sympathectomy, we prefer using the Botulinum Toxin (BOTOX® / Dysport). We do not use Sympathectomy because of the risks involved in it. They are rare, but real and may cause definitive complications as the syndrome of Horner, that is the fall of the eyelid, an unsightly complication, that cannot be corrected. This decision is mainly because of the risk of Compensatory Hyperhidrosis (profuse sweating in another part of the body as a consequence of Sympathectomy)
BOTOX® is already a widely known product, although there are others like Dysport and Myoblock. It is a substance that has been used by the medicine for a long time. In great doses, it is a powerful poison; in small doses, it is a wonderful medicine.

The Botulinum Toxin (BOTOX® / Dysport) is used for the treatment of muscular contractions, wrinkles, migraine, spasms, spastic paralyses, hyperactivity of sphincters, and many others fields of the medicine. Recently, new uses for this substance have been discovered, including the control of Hyperhidrosis.
When applied in the skin, the Botulinum Toxin turns the nerve of the sweat gland off. It is as if it turned off the light switch. The nerve is quite normal and so is the sweating gland, but there is no passage for the nervous impulse that provokes the sweating. As Hyperhidrosis is just a sweating abundance, the Botulinum Toxin is able to abolish Hyperhidrosis temporarily.

As the nerve is normal and so is the sweating gland , after a period of time that depends on the place where the Botulinum Toxin was injected in the body, there is a reconnection of the nerve and the gland. As a result, the nervous impulse reaches the gland and the sweating appears again. But the Botulinum Toxin (BOTOX® / Dysport) can be injected repeatedly, causing the Hyperhidrosis to decrease again.
If the necessity of re-injecting the Botulinum Toxin seems to be inconvenient, it is in fact a warranty that if any complication happens, they will be reversible. These problems are rare and practically inexistent. With Sympathectomy, things are different; if the procedure results in complications, they aren’t reversible.

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