Sweaty feet in adolescents-Early use of botulinum type A toxin in juvenile plantar hyperhidrosis

Pediatr Dermatol. 2018 Nov;35(6):784-786. doi: 10.1111/pde.13628. Epub 2018 Sep 4.


Background/objectives: Plantar hyperhidrosis can have severe social effects on children and adolescents. Therapeutic options include antiperspirants and surgical interventions (eg, sympathectomy). Botulinum type A toxin is approved for axillary hyperhidrosis in adults only. The aim of the study was the determination of effect and safety of botulinum type A toxin in plantar hyperhidrosis in juvenile patients.

Methods: Children and adolescents with idiopathic focal plantar hyperhidrosis were treated with 50-100 U of botulinum type A toxin per sole. Local anesthesia was provided using topical eutectic mixture of local anesthetics cream and ice, in combination with midazolam as an anxiolytic.

Results: Fifteen patients (aged 12-17) were included in the study. Best results were achieved with a dose of 75-100 U of botulinum type A toxin per sole. Two patients did not benefit from the therapy, and 11 (73%) were satisfied with the results. Nine patients (60%) experienced pain at the injection site for a maximum duration of 3 days. One patient reported transient focal weakness for 4 weeks.

Conclusion: Botulinum type A toxin seems to be a safe secondary treatment option for plantar hyperhidrosis in adolescents aged 12 and older. A dose of 75-100 U per sole resulted in a good therapeutic effect of variable duration in most patients. There were no severe side effects.

Keywords: adolescents; anesthesia; botulinum toxin; hyperhidrosis.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Anesthetics, Local
  • Botulinum Toxins, Type A / administration & dosage*
  • Botulinum Toxins, Type A / adverse effects
  • Child
  • Female
  • Foot / physiopathology
  • Humans
  • Hyperhidrosis / drug therapy*
  • Injections, Intradermal
  • Male
  • Sweat / drug effects
  • Treatment Outcome


  • Anesthetics, Local
  • Botulinum Toxins, Type A