Indications

Profuse sweating of the hands may be treated by BoNTA injections.

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 sweating of the hands.

Injection Technique

This is a painful procedure and sedation or general anesthesia is usually required. Because of the thick skin of the hands, topical anesthetics may not be well absorbed by callused hands. Numbing the hands in ice baths, using a regional block, or even sedation may be necessary.

Usually 100 BU (or 300 DU) is used for this treatment, divided evenly for each hand. The product is injected into the dermis in small wheals separated by 1.0 to 1.5 cm. Each injection is 0.05 to 0.1 mL, or approximately 1 to 2 BU or 3 to 6 DU per injection. Because of the thickness of the skin, a 30- or 26-gauge needle may be necessary.