Indications

Profuse sweating of the armpits can be treated with BoNTA. Results of treatment are impressive and can last up to a year.

Anatomic Considerations

Neurotoxins act by preventing release of acetylcholine from nerve endings at the neuromuscular junction, the effect of which is to inhibit muscle contraction. Acetylcholine is also the neurotransmitter for the sweat glands. Injection of botulinum toxin into sweat glands will prevent sweating and is an excellent treatment for patients who complain of profuse underarm sweating. The starch-iodine test can be performed prior to injection. The axilla is painted with Betadine and is left for a few minutes to air dry. Corn starch (available from a grocery store) is sprinkled lightly onto the axilla; a large makeup brush works well for this application. The areas of sweating will cause the cornstarch to turn black. The treatment area is marked with a surgical marker, and the starch and iodine are cleaned prior to injection.

This is a messy procedure and often unnecessary because most sweating usually occurs in the hair-bearing skin of the axilla. Touch-up treatments are occasionally required several weeks later if not all areas were adequately treated. A starch–iodine test can be helpful in these cases.