No compensatory sweating after botulinum toxin treatment of palmar hyperhidrosis

Br J Dermatol. 2005 Feb;152(2):329-33. doi: 10.1111/j.1365-2133.2004.06255.x.


Background: Primary focal hyperhidrosis is caused by excessive secretion by eccrine sweat glands, usually at the palms, soles and axillae. The underlying mechanism is unclear. In recent years botulinum toxin A has emerged as a useful treatment. Compensatory sweating, which is a major problem in many patients who have undergone transthoracic endoscopic sympathectomy for hyperhidrosis, has only rarely been reported after botulinum toxin. However, this potential side-effect of botulinum toxin treatment has not been systematically examined.

Objectives: To investigate if treatment with botulinum toxin A in hyperhidrotic hands may cause compensatory sweating at other skin locations.

Methods: In 17 patients with a history of palmar hyperhidrosis repeated measurements of evaporation were made before and up to 6 months after treatment of the hands with botulinum toxin A. Recordings were made at 16 skin areas and compared with subjective estimates of sweating.

Results: Following treatment, palmar evaporation decreased markedly and then returned slowly towards pretreatment values, but was still significantly reduced 6 months after treatment. No significant increase of sweating was found after treatment in any nontreated skin area.

Conclusions: Successful treatment of palmar hyperhidrosis with botulinum toxin does not evoke compensatory hyperhidrosis in nontreated skin territories.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Botulinum Toxins, Type A / adverse effects*
  • Botulinum Toxins, Type A / therapeutic use
  • Female
  • Foot / physiopathology
  • Hand / physiopathology
  • Humans
  • Hyperhidrosis / chemically induced
  • Hyperhidrosis / drug therapy*
  • Hyperhidrosis / physiopathology
  • Male
  • Neuromuscular Agents / adverse effects*
  • Neuromuscular Agents / therapeutic use
  • Skin Temperature / drug effects
  • Sweating / drug effects*


  • Neuromuscular Agents
  • Botulinum Toxins, Type A