Botulinum toxin: Pharmacology and injectable administration for the treatment of primary hyperhidrosis

J Am Acad Dermatol. 2020 Apr;82(4):969-979. doi: 10.1016/j.jaad.2019.11.042. Epub 2019 Dec 4.


Hyperhidrosis is a dermatological condition defined by excessive sweating beyond thermoregulatory needs with significant effects on patients' quality of life. Hyperhidrosis is categorized as primary or secondary: primary hyperhidrosis is mostly focal and idiopathic, whereas secondary hyperhidrosis is commonly generalized and caused by an underlying medical condition or use of medications. Various surgical and nonsurgical therapies exist for primary hyperhidrosis. Although botulinum toxin is one of the deadliest toxins known, when used in small doses, it is one of the most effective therapies for primary hyperhidrosis. Botulinum toxin injections are widely used as a second-line primary hyperhidrosis treatment option once topical treatment strategies have failed. This article provides an overview of the commercially available botulinum toxin formulations and their applications in the treatment of primary hyperhidrosis.

Keywords: Clostridium bacteria; abobotulinumtoxinA; axillary hyperhidrosis; botulinum neurotoxin; botulinum toxin; craniofacial hyperhidrosis; excessive sweating; incobotulinumtoxinA; onabotulinumtoxinA; palmar hyperhidrosis; plantar hyperhidrosis; prabotulinumtoxinA; primary hyperhidrosis; rimabotulinumtoxinB.

Publication types

  • Review

MeSH terms

  • Acetylcholine / metabolism
  • Acetylcholine Release Inhibitors
  • Axilla
  • Botulinum Toxins, Type A / administration & dosage*
  • Botulinum Toxins, Type A / adverse effects
  • Dose-Response Relationship, Drug
  • Exocytosis / drug effects
  • Humans
  • Hyperhidrosis / drug therapy*
  • Hyperhidrosis / etiology
  • Hyperhidrosis / physiopathology
  • Injection Site Reaction / etiology
  • Injection Site Reaction / prevention & control
  • Injections, Intradermal / methods*
  • Neuromuscular Junction / drug effects
  • Presynaptic Terminals / drug effects
  • Presynaptic Terminals / metabolism
  • Quality of Life
  • Sweat Glands / drug effects*
  • Sweat Glands / innervation
  • Sweat Glands / physiopathology
  • Treatment Outcome
  • United States


  • Acetylcholine Release Inhibitors
  • Botulinum Toxins, Type A
  • Acetylcholine