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How effective are lontophoresis and Botox for sweating?

How effective are iontophoresis and Botox injections for hyperhidrosis? Does it depend upon the pattern of sweating? Are they readily available on the NHS?

How effective are iontophoresis and Botox injections for hyperhidrosis? Does it depend upon the pattern of sweating? Are they readily available on the NHS?

Idiopathic hyperhidrosis is usually symmetrical and localised to the palms, soles and/or axillae. Less commonly the face can be involved, so-called craniofacial hyperhidrosis.

Iontophoresis is the process of introducing salt ions in solution through the skin usually for the treatment of hand and feet (technically very difficult to apply satisfactorily to axillae).

The mechanism of action is not known but it does seem to work very well in some patients. These 20-minute sessions are carried out three times per week until sweating is sufficiently reduced and then maintenance is required once or twice a month. Home devices are available so that if the procedure is effective in hospital, patients can purchase their own machine to use at home.

Botox is injected intradermally and produces sustained anhidrosis for palmar, axillary or facial sweating by irreversibly blocking release of acetylcholine. Multiple injections are required but treatment of the axilla is simple and well tolerated. Injection into palmar skin is painful and a regional wrist nerve block is often required.

The inactivation is permanent but normal turnover and repair means the effect is only temporary. Treatment usually needs to be repeated every three to six months. The production of antibodies to the toxin is a risk with continued use and is harmless, but will stop therapy from being effective.

Both treatments may be offered on the NHS and this will depend on local contracts and availability although iontopheresis is more easily and widely available.

Dr Olivia Stevenson is consultant dermatologist at Kettering General Hospital

Botox

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