Botox one way to address craniofacial hyperhidrosis
by Eve Glazier, M.D., and
Elizabeth Ko, M.D.
Dear Doctors: have been diagnosed with craniofacial hyperhidrosis. I was prescribed a drug called glycopyrrolate, but I could not tolerate the side effects. Based on evidence-based practice, what is the efficacy of Botox for this condition? I would like to try it.
IDear Reader: When someone has hyperhidrosis, it means they sweat excessively, despite the absence of typical triggers, such as heat, exertion or anxiety. The perspiration can be so heavy that it soaks through clothing or drips off the scalp, face, hands or soles of the feet. The excessive sweating occurs due to a malfunction in a signaling system in the skin. Specifically, certain sweat glands that bring perspiration to the surface of the skin are overreacting to the presence of a neurotransmitter, which is a chemical signal that is emitted by the nerve cells. The condition doesn’t pose a threat to health, but it can be stressful and embarrassing, and it often adversely affects quality of life.
Hyperhidrosis can be primary, which means it begins early in life, or secondary, which means it is caused by an outside stimulus. People living with primary hyperhidrosis often have a family history of the condition, which strongly suggests a genetic link. One of the most common causes of secondary hyperhidrosis are the hot flashes that occur in menopause. Additional causes include diabetes, thyroid problems, nervous system disorders and certain types of cancer. Medications, including opioids and some antidepressants, can also trigger the condition. So can cancer treatments, including radiation therapy and chemotherapy.
The condition can affect the whole body, or, as in your case, may be localized. Craniofacial hyperhidrosis means the person sweats excessively on the scalp, face and forehead. Glycopyrrolate, the medication that you were prescribed, is a drug used to treat ulcers. It blocks the neurotransmitter involved in activating the sweat glands, so it is often effective for hyperhidrosis. However, it can produce side effects that include headaches, bowel issues, dry mouth and difficulty urinating.
The good news is that Botox has been found to be safe and quite effective in treating hyperhidrosis. It works by blocking the nerve signals involved in sweating. Unlike oral medications, which affect sweat glands throughout the body, Botox injections are a targeted treatment. They can be used to specifically address localized hyperhidrosis. Treatment consists of multiple injections in and around the affected area. Numbing cream is used to help manage pain. The treatment is not recommended for women who are pregnant or breastfeeding, or for anyone with a history of neuromuscular disorders.
Results begin several days after treatment and become fully evident within two weeks. The effect lasts for six months or longer, after which treatment must be repeated. The most common side effects of Botox injections are pain, stinging or swelling at the injection site. Patients seeking help with sweating on their palms need to be aware that Botox can cause temporary muscle weakness. The specific placement of the injections is key to successful treatment, so it is important to seek out a physician who is experienced in using Botox in this context.
(Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.)