what is it?
Botulinum toxin type A is a prescription only medicine frequently referred to as Botox® which is the brand name and original form of the drug produced by the company Allergan and what is now part of AbbVie Ltd. There are now other companies who make botulinum toxin licensed for treating hyperhidrosis with different product names like Dysport (Ipsen Ltd).
How does it work?
It is known as a neurotoxin. The toxin works by blocking the chemical, acetylcholine, at the end of the nerves so that it cannot work on the glands or muscles that the nerve is stimulating. That is how it is used in aesthetics to essentially paralise the facial muscles to treat wrinkles.
In the case of the sweat glands it stops the sympathetic nerves releasing acetylcholine and stimulating the sweat glands. It is the same effect as anticholinergic drugs.
At the ends of nerves the signalling chemicals are enclosed in a synaptic membrane, known as a vesicle, similar to the cell membrane that encloses all our cells. When stimulated, this vesicle fuses with the cell membrane a little like when bubbles coalesce together. The contents of the vesicle are then released out of the cell to activate the target. This process is made possible by the SNARE complex (Soluble NSF Attachment protein Receptor), in this case known as SNAP-25. Botulinum toxin cleaves or cuts the SNAP-25 to prevent the vesicle containing acetylcholine fusing with the cell membrane and being released in the nerve synapse, for more information visit this page.
In the case of the sweat glands it stops the sympathetic nerves releasing acetylcholine and stimulating the sweat glands. It is the same effect as anticholinergic drugs.
At the ends of nerves the signalling chemicals are enclosed in a synaptic membrane, known as a vesicle, similar to the cell membrane that encloses all our cells. When stimulated, this vesicle fuses with the cell membrane a little like when bubbles coalesce together. The contents of the vesicle are then released out of the cell to activate the target. This process is made possible by the SNARE complex (Soluble NSF Attachment protein Receptor), in this case known as SNAP-25. Botulinum toxin cleaves or cuts the SNAP-25 to prevent the vesicle containing acetylcholine fusing with the cell membrane and being released in the nerve synapse, for more information visit this page.
What is it used for?
It is now used widely to treat a wide variety of medical problems including hyperhidrosis but is probably more widely known for its cosmetic uses to remove lines and wrinkles in the face. It is licensed to treat muscle spasticity such as in cerebral palsy, limb spasticity and facial spasms, chronic migraines and bladder dysfunctions.
It is gernerally very effective for treating hyperhidrosis BUT the effects eventually wear off after about three to six months.
It is gernerally very effective for treating hyperhidrosis BUT the effects eventually wear off after about three to six months.
is botulinum toxin available on the nhs?
In the UK, there are only a very small number of NHS hospitals that still offer botulinum toxin and those that do only in selected cases and it often requires individual funding requests .
It is mostly a private treatment in the UK, you can use the doctor finder to find a clinic near you.
It is very important to check that the practitioner administering the botulinum toxin injections has been trained to use it for hyperhidrosis and not just for aesthetics as the technique is very different.
It is mostly a private treatment in the UK, you can use the doctor finder to find a clinic near you.
It is very important to check that the practitioner administering the botulinum toxin injections has been trained to use it for hyperhidrosis and not just for aesthetics as the technique is very different.
how is it done?
It requires multiple small injections of the toxin a few centimetres apart in the armpit. Although not licensed, some doctors do use it for treating hyperhidrosis of the hands, feet, other parts of the body and even the face. As you can imagine, injections here tend to be more uncomfortable and usually require a local anaesthetic.
what can go wrong?
As long as the doctor doing the treatment is experienced and knows the anatomy of the surrounding area then there are rarely any serious side effects. It can affect the nearby muscles making them weak. This could be of greater concern in the face. Pain at the site of the injections is not uncommon. Sometimes patients experience headaches, flu-like symptoms, tiredness and blurred vision. Up to 10% of people develop antibodies against the toxin meaning it will no longer work or not work as effectively.
It is very important to discuss all of the possible side effects and complications with your doctor that are relevant to you and the site of injection of the toxin before you consent to treatment.
It is very important to discuss all of the possible side effects and complications with your doctor that are relevant to you and the site of injection of the toxin before you consent to treatment.
