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Treatment of armpits and hyperhidrosis of limbs by botulinum injection



Treatment of armpits and hyperhidrosis of limbs by botulinum injection

Hyperhidrosis is a disease in which the amount of sweat used to regulate body temperature is abnormally high. It develops in areas with sweat glands such as armpits and palms, and it is said that 1 in 10 people in Japan has hyperhidrosis .

One method of treating hyperhidrosis is botulinum injection without a scalpel. Botulinum toxin, which is a component of botulinum injection, acts on the sympathetic nerves that prompt the command of sweating, and can be expected to improve hyperhidrosis by suppressing sweating from the sweat glands.

Treatment of hyperhidrosis by botulinum injection is a treatment that can be performed easily with a short treatment time, but it is said that the effect of the treatment differs depending on the skill of the doctor. Therefore, in order to treat hyperhidrosis with reduced risk, it is necessary to know in advance the risks and side effects of botulinum injection and the duration of efficacy of the drug.

Diagnostic criteria for hyperhidrosis classified as mental sweating

Sweat is secreted by the eccrine sweat glands on the skin surface of the whole body and the apocrine sweat glands on the armpits and abdomen in response to signals from the sympathetic nerve, which is one of the autonomic nerves, to regulate the body temperature.

Hyperhidrosis is a condition in which the sweat glands are stimulated by excessive signals from the sympathetic nerves, causing sweating that exceeds the amount of sweat required to regulate body temperature. Hyperhidrosis can occur in a variety of areas, mainly on the sides, face, palms, and soles of the feet.

Sweating is classified into mental sweating, thermal sweating, and taste sweating , of which hyperhidrosis is classified as mental sweating caused by stress and tension.

Mental sweating Sweating due to stress and tension
Thermal sweating Sweating to regulate body temperature that has risen due to exercise etc.
Gustatory sweating Sweating caused by eating hot and spicy foods and stimulating taste

Diagnostic criteria for hyperhidrosis

A large amount of sweat does not mean that you are diagnosed with hyperhidrosis, but you will be diagnosed with hyperhidrosis by a doctor if you meet certain conditions. Hyperhidrosis may be diagnosed if unexplained sweating has continued for more than 6 months and two or more of the following diagnostic criteria are met.

  • The first symptoms were under 25 years old
  • Symmetrically secretes sweating
  • Sweating subsides during sleep
  • Have episodes of hyperhidrosis at least once a week
  • I have a family member with hyperhidrosis
  • Hyperhidrosis affects daily life

Hyperhidrosis includes local hyperhidrosis in which sweating of a part of the body becomes active and systemic hyperhidrosis in which sweating of the whole body becomes active, and it is said that about 90% is local hyperhidrosis. I will. The above criteria are for local hyperhidrosis, and for systemic hyperhidrosis, underlying diseases such as malignant lymphoma, neurological disease, endocrine and metabolic disorders, and pheochromocytoma are suspected.

If you have a disease, you tend to sweat from the whole body rather than locally, so if you do not know the cause and sweat an abnormal amount on the whole body, consult a medical institution to see if the disease is hidden. Need to be inspected.

Both local and systemic hyperhidrosis can be divided into primary hyperhidrosis of unknown cause and secondary hyperhidrosis caused by some illness or drug. In order to treat secondary hyperhidrosis radically, it is necessary to treat the causative disease, not botulinum injection.

Characteristics of hyperhidrosis by site

Facial hyperhidrosis

Facial hyperhidrosis is often associated with "head hyperhidrosis," which causes a large amount of sweat on the head .

Axillary hyperhidrosis

Axillary hyperhidrosis is a symptom that is so familiar that it is not recognized as a disease, and not many people go to a medical institution, but about 1 in 20 people in Japan has axillary hyperhidrosis. It is said to be hyperhidrosis.
Sweat glands are concentrated on the sides, and thermal sweating, taste sweating, and mental sweating are all promoted, so it is a part that is easy to sweat. In addition, the sweat secreted by the apocrine glands contains components that feed on the indigenous bacteria on the skin, so the increased amount of sweating causes the bacteria to multiply and cause armpits.

Palm (shusho) hyperhidrosis and footpad (sokuseki) hyperhidrosis

Palmar hyperhidrosis and footpad hyperhidrosis tend to develop in combination, and the two symptoms are collectively called palmoplantar hyperhidrosis . It is possessed by about 1 in 20 people in Japan, and is the second most common site after axillary hyperhidrosis.

Treatment of hyperhidrosis with botulinum injection

Ingredients and effects of botulinum injection

The drug used for injection of botulinum is a type of protein called botulinum toxin extracted from Clostridium botulinum, which is also known as food poisoning. Since it is a decomposed and refined component that is thought to be harmful to the body, it has no effect on the human body.

Botulinum toxin acts at the junction of nerves and muscles and temporarily paralyzes muscles by suppressing the action of a neurotransmitter called acetylcholine, which works when the brain commands muscles. In cosmetology dermatology, the main uses are treatments that aim to improve facial expression wrinkles by injecting botulinum toxin into muscles to relax tension, and treatments that improve gill tension due to muscle development.

In addition, it also suppresses the sweating signal commanded by the sympathetic nerves, so hyperhidrosis can be treated by applying it to the sides, hands, and soles where there are many sweat glands. By injecting botulinum into the dermis layer of the area of concern, it suppresses the release of acetylcholine, a neurotransmitter that commands sweating, and blocks the transmission of information from nerves to the sweat glands.

Type A botulinum toxin is used in aesthetic medicine

Botulinum toxin ranges from type A to type G, of which the formulations used in the human body in medicine and cosmetology are types A and B. Type A is effective 2 days to 2 weeks after treatment and lasts for 3 to 4 months, but type B is effective for about 1 month, so type A botulinum injection is used in cosmetology. There is a tendency.

The botulinum injection used in aesthetic medicine is known as the so-called "botox injection" . However, Botox is not strictly a treatment name because it is registered as a trademark by Allergan, Inc. and refers to "Botox Vista," a botulinum toxin preparation approved by the Ministry of Health, Labor and Welfare.

Whether or not there is insurance for hyperhidrosis treatment by botulinum injection

In the case of "axillary hyperhidrosis", treatment with botulinum injection may be covered by insurance if the criteria for diagnosing hyperhidrosis are met . Not all people who are concerned about armpit sweat are covered, and only if the doctor diagnoses them with severe hyperhidrosis.
However, insurance may be applied when treating palmoplantar hyperhidrosis with treatment methods other than botulinum injection.

Duration of effect of botulinum injection in the treatment of hyperhidrosis

Treatment of hyperhidrosis by botulinum injection can be expected to work in 2 to 3 days regardless of the site and suppress sweat secretion.

The duration of the effect is 4-9 months . Since botulinum injection is not a treatment aimed at completely curing hyperhidrosis, sweat gland activity becomes active again when it becomes ineffective, but regular botulinum injection can suppress hyperhidrosis each time. I can do it.

Treatment of hyperhidrosis other than botulinum injection

Treatment methods for hyperhidrosis include not only injection of botulinum, but also surgery to improve hyperhidrosis by removing the sweat glands and treatment methods using topical drugs.

Sweat gland resection to remove sweat glands by incising the skin of the armpit

By removing the skin of the armpit and removing the sweat glands, sweat secretion can be suppressed . Unlike botulinum injection, removing the sweat glands reduces the recurrence rate of hyperhidrosis and armpits, but it may leave scars because the skin is incised about 4 cm to 5 cm .
While the downtime is longer than that of botulinum injection, one operation can be expected to improve hyperhidrosis . However, because the skin is sutured, it is necessary to rest for about 3 days to prevent the sutured wound from opening, and it is necessary to go to the hospital for follow-up and suture removal. Sweat gland resection is covered by insurance, so please consult your doctor.

Chest sympathetic blockade to remove nerves that promote sweating

In palmoplantar hyperhidrosis, sweating is promoted via the thoracic sympathetic nerve by a command from the cerebrum. Palmoplantar hyperhidrosis occurs when nerves T2 to T6, which are related to sweating of the hands, occur in the chest, so palmoplantar hyperhidrosis is a method of removing the nerves in the chest to suppress sweating. It is said to be effective for illness .

Chest sympathetic blockade is an insurance-covered surgery that may improve not only palmoplantar hyperhidrosis but also other areas of hyperhidrosis such as armpits and head. After surgery, it may be difficult to take a deep breath or the chest may hurt, but it often subsides in about a week, and the skin of the armpit can be excised by about 2 mm to 4 mm, so scars are less likely to remain .

As a side effect, instead of suppressing sweating on the palms with chest sympathetic blockade, you may develop "compensatory sweating" that sweats from the thighs, hips, and buttocks. It is said that narrowing the excision range of nerves alleviates the symptoms of compensatory sweating, but the mechanism of compensatory sweating is often unsolved, and it is predicted that compensatory sweating will occur before surgery. It is considered difficult.

Topical aluminum chloride therapy to block sweat glands

Topical aluminum chloride, which is an ointment, suppresses sweat secretion by blocking the outlet of sweat glands. It is said that by continuously applying it to the affected area, the sweat glands can be gradually reduced and the secretion of sweat can be suppressed. However, since the skin may become irritated or rash , the frequency of use and dosage , It is important to keep the concentration. Topical aluminum chloride can be obtained at pharmacies, but if prescribed at a medical institution, there are no insurance-covered drugs in Japan, so medical treatment is free.

Iontophoresis in which the affected area is immersed in electrolyzed water

It is a method aimed at improving hyperhidrosis by immersing the affected area in tap water with a weak electric current, and is mainly used for the treatment of palmoplantar hyperhidrosis. There are various theories, but it is said that hydrogen ions generated by electrolyzing water may block the outlets of sweat glands and suppress sweating.

People with pacemakers or heart problems should consult with a doctor before undergoing a procedure as they conduct current through the body . Iontophoresis can suppress hyperhidrosis by receiving continuous treatment, and it can be performed for about 1,000 yen at a time with insurance coverage, so the cost can be kept low compared to botulinum injection.

Downtime and risk of treating hyperhidrosis with botulinum injection

Downtime for treating hyperhidrosis with botulinum injection

Since botulinum injection is injected into the shallow part of the skin such as the dermis layer where sweat glands are located and the subcutaneous tissue, there is a swelling like an insect bite immediately after the treatment, but the swelling subsides in about 3 to 4 hours. .. In addition, the redness that develops after injection subsides within half a day to a day, and in rare cases internal bleeding may occur at the injection site. However, since it is injected little by little with a fine needle, the risk of damaging blood vessels is low, and even if internal bleeding should occur, it will improve in about 10 days.

Risks and side effects of hyperhidrosis treatment with botulinum injection

Compensatory sweating

Treatment of hyperhidrosis by botulinum injection may rarely cause compensatory sweating that activates sweating outside the treatment site, but botulinum injection is a treatment that acts only on a small area, so compensatory hyperhidrosis The risk of developing the disease is low.

Swelling and redness

After the botulinum injection, the injection damages the skin, which may cause redness and swelling, but it is said that it will subside in about a week.

Diminished effect by short-term administration

Repeated injections of botulinum may produce neutralizing antibodies to botulinum toxin in the body, reducing the effectiveness of the procedure. Therefore, most medical institutions allow a period of 4 months or more before re-administration. Although there are individual differences, the amount of botulinum toxin produced by neutralizing antibodies is said to be 2,000 to 4,000 units.

However, there is also a formulation called "Zeomin", a type A botulinum toxin that suppresses the production of neutralizing antibodies. Since the products handled by medical institutions differ, please contact the medical institution if you are concerned about the risk of short-term administration.

Numbness and contracture of muscles due to lack of doctor's skill

Unlike the treatment of facial wrinkles, which is performed in the treatment of hyperhidrosis, botulinum injection is injected into the dermis layer and subcutaneous tissue where sweat glands are located. However, when injected into the muscle due to lack of skill of the doctor, side effects such as numbness of the treatment site and contracture that makes it difficult to move may occur due to the suppression of muscle function .

The effect of botulinum injection is not permanent, so it will be less effective in about half a year and there will be no side effects on the muscles. Injecting acetylcholine chloride, which suppresses the action of botulinum toxin, can also be expected to alleviate side effects.

What you need to know in advance when treating hyperhidrosis with botulinum injection

Those who need consultation with a doctor when receiving treatment

  • Those with muscle disease
  • Those who are allergic to botulinum toxin
  • Those who have had food poisoning due to Clostridium botulinum
  • People with respiratory diseases and glaucoma
  • Those with systemic neuromuscular junction disease
  • Those with urinary tract infections
  • Those who are using other medicines including over-the-counter medicines
  • Contraindicated if you are pregnant, may be pregnant, or breastfeeding

If you have any of these symptoms, consult your doctor before the procedure. As a result of consultation with your doctor, you may not be able to receive the treatment.

Botulinum injection volume and price quotes for the treatment of hyperhidrosis

Part Estimated injection amount Price quote
(Head hyperhidrosis)
150 units ~ 40,000-300,000 yen (own expense medical treatment)
Forehead and nose
(Facial hyperhidrosis)
100 units ~ 30,000 yen to 100,000 yen (own expense medical treatment)
(Axillary hyperhidrosis)
50 to 100 units on both sides 20,000 yen to 140,000 yen (insurance coverage)
(Palmoplantar hyperhigosis)
Both hands 100 to 150 units 40,000 yen to 120,000 yen (own expense medical treatment)
(Foot-foot hyperhidrosis)
Both feet 200 to 300 units 40,000 yen to 120,000 yen (own expense medical treatment)

In the case of botulinum injection, the amount of drug injected is expressed in "units" instead of ml or cc, and 100 units is equivalent to five 1 ml syringes.

Basic procedure for treating hyperhidrosis by botulinum injection

(1) Counseling

Fill out a checklist for hyperhidrosis, check the degree of sweating, and collect blood if necessary. Also, fill out the treatment consent form.

(2) Medical examination / anesthesia / cooling

If desired, an anesthetic cream or cooling to cool the affected area is applied. Depending on the medical institution, you may be prescribed an anesthetic cream at the first visit and instructed to apply it at home before visiting the hospital.

(3) Injection

Inject with a fine needle into the desired treatment site so that there is less pain. It takes about 10 to 30 minutes depending on the injection amount.

(4) Cooling / end

After the treatment, some medical institutions may perform cooling. Avoid squeezing or irritating the treatment area. You can apply make-up after the treatment.

Depending on the medical institution, you may be able to receive treatment on the same day.

Things to refrain from after receiving the treatment

  • Massage and strong stimulation to the treatment site
  • contraception
  • Long bathing and drinking
  • Vigorous exercise
  • Esthetic massage

Combined use of medical laser hair removal is effective for treating armpit hyperhidrosis

A synergistic effect of treating hyperhidrosis and armpits can be expected by using a medical laser hair removal treatment that aims for long-term hair loss and hair removal.
Apocrine sweat glands, which secrete sweat that promotes the growth of bacteria, are present in the form attached to the pores and are mainly concentrated in the armpits. The presence of hair makes it easy for sweat to get stuffy, and the growth of bacteria causes an odor. Hair loss and hair loss make it difficult for sweat to stay, and by preventing the growth of bacteria, the odor can be suppressed.