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botulinum toxinBotulinum toxin is a toxin from the Bacterium “chlostridium botulinum”, which prevents perspiration.
The effect directly unfolds in the periphery of the sweat gland. Each sweat gland receives impulses from a nerve to release sweat. As soon as a signal reaches the nerve, a transmitter substance (acetyl choline) is delivered, which activates the sweat gland. Botulinum toxin irreversibly blocks the release of this substance and the sweat gland is consequently shut down for some time. Only after several months, after the formation of new nervous extensions, perspiration starts again.

The treatment with botulinum toxin requires the substance to be injected under the skin in extreme dilution. It is evenly distributed over the entire surface affected. This requires about 40-50 stitches, depending upon which part of the body is concerned. The effect remains for approximately 6 months. After this period, perspiration slowly increases again, which eventually requires an intervention anew. Due to antibodies towards the toxin, some patients do not respond, or hardly respond to this treatment though.
The disadvantages of this treatment amongst other things are high costs and the temporarily limited effect. Without adequate anesthesia the treatment is painful, particularly for hands and feet. Motor skills of the hands can be disturbed for some time after the injection (attenuation of finger muscles). The toxin can neither be applied on the face without significant disturbance of facial expression due to palsy of facial muscles. Therefore this treatment is not suited for facial hyperhidrosis.
The treatment method with botulinum toxin is not yet fully developed, thus not all risks that this nerve poison brings about, are known up till now. Before such a treatment is taken into consideration, the external treatment methods should have been fully exploited in every case.