Botulinum toxin, better known as Botox®, is today a widely recognized solution for the treatment of localized hyperhidrosis. Approved by health authorities, including the FDA and EMA, this technique significantly reduces sweat production in targeted body areas. Botox works by temporarily blocking the release of acetylcholine, the neurotransmitter responsible for activating sweat glands. This non-invasive, effective, and well-tolerated approach represents a valuable alternative to topical or surgical treatments. But which anatomical areas can actually benefit from this treatment? An overview of the most frequently treated areas.
The underarm area is the most commonly treated location with botulinum toxin injections. Axillary hyperhidrosis affects a significant proportion of patients with excessive sweating, often impacting social and professional life: stained clothing, unpleasant odors, and constant discomfort.
Botox treatment in this region yields very satisfactory results: sweating is reduced by 80 to 95%, with effects lasting 5 to 6 months, or even longer in some patients. The procedure is quick (30 to 45 minutes), minimally painful, and performed without general anesthesia. Generally, about fifteen superficial injections per armpit are sufficient to effectively treat the area.
Excessive sweating of the hands, or palmar hyperhidrosis, is particularly disabling socially and professionally. It interferes with daily activities (handshakes, writing, using touch devices) and can cause significant psychological distress.
Botox injections in the palms provide excellent results but require precise technique and, in most cases, local anesthesia via nerve block due to the sensitivity of this area. The effectiveness is comparable to that seen in the underarms, although the duration of action is sometimes slightly shorter (4 to 6 months). Transient side effects, such as hand muscle weakness, may occur, but they are rare and reversible.
Less frequently treated but equally bothersome, plantar hyperhidrosis can be managed with Botox, especially when topical treatments prove ineffective. Excessive sweating of the feet often causes discomfort in shoes, persistent odors, and skin complications (maceration, fungal infections).
The treatment is, however, more technical and often less comfortable for the patient. Local anesthesia is applied to reduce the pain caused by multiple injections in the soles of the feet. Results are satisfactory, with a significant reduction in sweating, although the effect typically lasts 4 to 6 months. This treatment is offered to carefully selected patients, after secondary causes have been ruled out.
Excessive facial sweating, particularly on the forehead, scalp, or temples, is an increasingly common indication.
These highly visible areas make hyperhidrosis particularly bothersome, both in social interactions and for aesthetic reasons (running makeup, wet hair, persistent shine).
In these areas, Botox is administered with caution to avoid any adverse effects on the muscles involved in facial expressions. The injection protocol is carefully adapted to the patient’s morphology, with low doses strategically distributed. The effect appears within 3 to 7 days, providing a noticeable improvement in quality of life for the affected patients. The effect generally lasts 4 to 6 months.
Although less common, some diffuse but focused hyperhidrosis on the back, chest, or sternal region can also be treated with botulinum toxin. These locations pose technical challenges, particularly due to the surface area to cover and the depth of the sweat glands. Botox can be used in these cases, often combined with other approaches such as oral anticholinergics or iontophoresis. The suitability of the treatment depends on symptom severity and the impact on quality of life.
The inguinal, perineal, or pubic areas can also be affected by excessive sweating, often with an underestimated impact. Intimate discomfort, maceration, and recurrent local infections make hyperhidrosis in this region highly disabling. Botox, injected in a targeted manner by an experienced physician, can significantly reduce sweat production, with good tolerance and lasting effectiveness.
This treatment requires strict adherence to aseptic protocols and careful patient evaluation. It is generally offered after topical treatments have failed or when the psychological impact is significant.
The use of Botox in the treatment of localized hyperhidrosis is based on solid clinical data, with an excellent safety profile. Side effects are rare, most often transient: pain or bruising at the injection site, slight muscle weakness depending on the area, or sensations of tension. There is no phenomenon of compensatory sweating in other areas of the body.
Repetition of injections is possible without loss of efficacy, with an average interval of 5 to 6 months depending on the patient and the treated area.
It is entirely possible to treat multiple areas of the body during the same session of botulinum toxin injections. This approach is particularly indicated for people suffering from localized but multifocal hyperhidrosis, for example in the underarms and palms or even the face and feet. The doctor adjusts the total dose of botulinum toxin according to the targeted areas, their extent, the intensity of hyperhidrosis, as well as the clinical specifics of each patient.
However, there are limits related to the dosage that must be respected to ensure the safety of the treatment. The maximum dose of Botox (in international units) should not exceed certain thresholds per session, according to the manufacturer’s recommendations and clinical data. When multiple areas need to be treated, the treatment can be spread over several sessions, generally spaced a few weeks apart.
The possibility of treating multiple regions simultaneously therefore depends on a precise medical evaluation, aimed at balancing therapeutic efficacy, individual tolerance, and pharmacological safety. This combined protocol is likely to provide overall and prolonged relief to patients with multifocal hyperhidrosis.
It is possible to suffer from localized hyperhidrosis without sweating excessively all over the body. In fact, this is the most common form of hyperhidrosis: primary localized hyperhidrosis. Unlike secondary hyperhidrosis, which tends to be generalized and linked to an underlying condition (endocrine disorder, infection, cancer, etc.), primary hyperhidrosis manifests in a localized, symmetrical, and isolated manner on one or more specific areas of the body, without affecting overall sweating.
The most common locations are the underarms (axillary), hands (palmar), feet (plantar), and face (cranio-facial). These areas have a high concentration of eccrine sweat glands that are particularly sensitive to cholinergic stimulation, often exacerbated by stress or emotion. Affected patients show no metabolic or infectious abnormalities, and their overall health is perfectly normal.
It is therefore entirely possible—and common—for a patient to sweat excessively in the hands or underarms, while having normal, or even moderate, sweating elsewhere on the body. The precision of the injection site is what makes the use of botulinum toxin so effective. By specifically targeting the affected areas, its action remains strictly localized, allowing the problem to be treated effectively without altering the body’s overall thermal regulation.
Article written by Dr Romano Valeria
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