Gene Rubinstein, M.D., F.A.A.D.
(818) 505-9300
Hyperhidrosis: Excessive sweating of the palms, feet or underarms

Treatment option:   
Botulinum Toxin A Injections (Botox®)

Text taken from the International
Hyperhidrosis Society website)

Botulinum toxin (most commonly known in the US as Botox®) is a natural, purified protein with
the ability to interrupt the chemical messages released by nerve endings.

For hyperhidrosis, botulinum toxin works by blocking the nerves that stimulate the sweat
glands. Botulinum toxin is derived from bacteria in much the same way penicillin is derived
from mold. Botulinum toxin has been safely used to treat millions of people for more than 10
years for several therapeutic conditions.

Using botulinum toxin to alleviate the symptoms of hyperhidrosis is a promising new approach.
Research has shown that treating armpit, hand, facial, and gustatory (related to salivation or
eating) hyperhidrosis with botulinum toxin is safe and effective. In recent studies, when
botulinum toxin was injected into under arm areas affected by hyperhidrosis, excessive
sweating was relieved for an average of seven months. And 28% of those studied, the
anhidrosis (or lack of sweating) lasted sixteen months.

When treatment of underarm hyperhidrosis with topical antiperspirants has been
unsuccessful, botulinum toxin is a highly effective and convenient alternative. The injections can
be performed in a physicians office, require little time, and do not demand any restrictions in
work or leisure activity (aside from refraining from intensive exercise or the use of a sauna on
the day of the injections).

It’s important to note that the U.S. Food and Drug Administration (FDA) approved botulinum
toxin for axillary hyperhidrosis on July 19th, 2004. It should also be noted that botulinum toxin
has been approved for use in hyperhidrosis by regulatory authorities in over half a dozen other
countries, including Canada and certain countries in Europe and South America. Keep in mind,
also, that it may take several injection sessions to achieve desired results and that during each
injection session multiple injections are given in an attempt to cover the entire affected area.
These injections can be painful especially in the palms and soles of the feet. In addition,
although botulinum toxin stops sweating, it doesn't prevent body odor.

Treatment with botulinum toxin for hyperhidrosis requires that small amounts of the protein be
injected into or near the sweat glands responsible for excessive perspiration. One of the
botulinum toxin products used by doctors in the U.S. is called Botox®.

Follow-up injections to maintain the antiperspirant effect are necessary. These repeat
injections may be required at intervals varying from seven to sixteen months. Injections into the
palms or soles may be painful, so a local anesthetic (painkilling) cream or other pain relief
methods may be used during the procedure. Following the injections, full effect is normally
achieved within 24 to 72 hours.

Side effects
Side effects of botulinum toxin injections can include small amounts of bleeding into the skin at
the injection site and mild temporary weakness of muscles near the injection sites, particularly
small hand muscles. Minor discomfort such as a stinging sensation may be felt during the
injections. Temporary skin rashes, flu-like symptoms, or fatigue may occur within days after
treatment. Temporary bruising is also possible. These side effects, if experienced, usually go
away quickly.

Underarm injections are easier to give and less painful than injections into the palm due, in
part, to softer skin in the armpits. Additionally, armpit injections are less likely to cause muscle

You should not receive botulinum toxin treatment if you have generalized muscular weakness,
a neuromuscular disorder, progressive myopathies, or profound atrophy of the targeted area, or
if you have been on certain types of antibiotic therapy. Additionally, pregnant or breastfeeding
women should not use botulinum toxin, and the injections should not be given if the proposed
injection site is infected in any way.

Treatment may be covered by medical insurance.  Coverage depends on your benefits and
medical necessity or as authorized and determined by your insurance company.  Please call
the office for details
Don't suffer with sweaty palms,
feet or underarms.  The latest
treatment for hyperhidrosis is


Call us to schedule an
appointment with Dr. Rubinstein
to discuss this treatment.  

Help is just a phone call away.
Our patients say:

I no longer feel embarrassed to
shake hands when I meet
people.  You gave me self
confidence I never had.

I handle glass at work and my
sweaty palms made my work life
difficult.  Thank you for helping
me in such a big way.

I no longer have to wear heavy
socks.  My feet feel great.  Thank
you, I’ll be back for future

I am not only glad that I did this
great and fairly easy procedure,
but my insurance company
covered my treatments.  It lasted
8 months and now I am back for
my next treatment.

I had surgery, and it helped my
feet, but not my hands.  Botox
treatment helped my hands
tremendously.  I wish I  knew
about this option before I had
Dr. Rubinstein was recently
featured on NBC in Los Angeles.  
"What women do to wear high
heels" featuring Botox and
Restylane injections into the feet.
video link)
(818) 505-9300
Gene Rubinstein, M.D.
Dermatologist and Harvard Trained Laser Specialist
Medical and Cosmetic Dermatology