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Commonly used for wrinkle reduction, Botox is a high-performance injectable that consists of botulinum toxin. It visibly diminishes crow’s feet, glabellar lines between eyebrows, and forehead lines, helping to create a younger-looking skin. Many people do not realize that Botox can be used for other clinical indications. This includes overactive bladder (OAB), spasticity, blepharospasm (associated with dystonia) cervical dystonia, and urinary incontinence (due to detrusor overactivity associated with neurologic conditions e.g. multiple sclerosis). Apart from that, Botox has shown remarkable effectiveness in the management of hyperhidrosis (excessive sweating).
Hyperhidrosis is condition characterized by abnormally excessive sweating that is not related to exercise or heat. The heavy sweating caused by hyperhidrosis significantly exceeds normal sweating caused by a hot environment or stress. In patients with hyperhidrosis, the sweating usually occurs bilaterally (on both sides of the body). The condition may affect body parts such as the face, underarms, feet, and hands. There are many forms of hyperhidrosis, including palmoplanter hyperhidrosis (excessive sweating of the soles of the feet and palms of the hands) and axillary hyperhidrosis (excessive sweating of the armpits).
To be diagnosed with hyperhidrosis, there should be at least 1 episode per week during waking hours. This type of profuse sweating often results when embarrassed and or when experiencing social anxiety, potentially causing social withdrawal. In severe cases, hyperhidrosis may disrupt daily functioning of the patients, ultimately affecting their quality of life. Excessive sweating may sometimes indicate the presence of a more serious underlying condition. As a precaution, seek medical help right away if profuse sweating is accompanied by symptoms such as nausea, chest pain, and lightheadedness or dizziness. Patients are advised to see a doctor if symptoms become bothersome or worsen.
Hyperhidrosis can be treated using prescription drugs (such as pills and lotions) or over the counter (OTC) products. Patients who are unresponsive to these treatments may resort to surgery (which involves the disconnection of the nerves that cause excessive sweat production, or removal of the sweat glands). However, surgery is linked to a higher risk of complications. Administered via minimally-invasive injections, Botox offers a simple and painless way of treating hyperhidrosis. Botox is approved for use in more than 23 countries worldwide, including the United Kingdom, Canada, and other countries in South America and Europe. The botulinum toxin type A injection has obtained FDA approval in 2004 for the symptomatic treatment of severe primary axillary hyperhidrosis in adult patients who are unresponsive to topical treatments (such as antiperspirants).
Manufactured by Allergan, Botox contains botulinum toxin type A (a neurotoxin produced from Clostridium botulinum) as the active ingredient.
The mechanism of action of Botox in hyperhidrosis has not been fully elucidated. It is believed that Botox inhibits the presynaptic release of acetylcholine (ACh) from the cholinergic nerve terminal. After binding to the cholinergic receptors through the H chain, Botox is endocytosed and internalized, thereby blocking the release of acetylcholine.
Botox can be used on areas such as the groin, forehead, scalp, soles, palms, and underarms. In fact, it can be used on virtually any body part with excessive sweating.
To treat hyperhidrosis, administer Botox into the affected areas via small injections. Each treatment takes about 10 to 20 minutes to complete. Botox injections should only be performed by licensed medical practitioners that have undergone adequate training.
Designed to be minimally invasive, Botox injection is virtually pain-free. Patients may feel tiny pinpricks in the armpits. To minimize discomfort, use an anesthetic cream to numb the treatment site. Alternatively, apply ice packs during the treatment. Practitioners may also prescribe acetaminophen (otherwise known as paracetamol) 1 hour before injecting Botox.
While symptomatic improvements can be observed several days after treatment, it usually takes about 1 to 2 weeks to achieve optimal results. Some patients may notice improvement 2 to 3 days after treatment. The onset of action may differ among individuals.
Botox can provide symptomatic relief for around 6 to 12 months, after which the results will start to disappear. For longer-lasting results, repeat the treatments periodically.
In general, Botox is not known to cause any downtime after treatment. Most patients can return to work several hours after the procedure.
The unit price of Botox ranges from $11 to $16. Please note that the price may vary among providers.
As with other injections, Botox is associated with side effects such as:
All botulinum toxin-based injections (including Botox) have a risk of causing severe adverse reactions such as botulism resulting from the spread of toxin effects.
Patients who have previously had problems swallowing and breathing are at a higher risk of experiencing issues swallowing or breathing after treatment. The symptoms typically occur a few hours or weeks after the injection.
If these serious side effects occur, seek medical attention urgently. This is not a complete list of all the potential side effects of Botox. Occasionally patients may experience unexpected side effects, in which case they should consult a doctor. Refer to the product insert for a full list of side effects.
Prior to the treatment, practitioners will perform a medical examination to determine if the patient is suitable for a Botox injection. At the same time, doctors will take a complete medical history (including medication history) to detect any potential contraindications.