Hyperhidrosis Treatment: Botox for Excessive Sweating

Part of our complete guide to Anti-Wrinkle Injections.

Last updated: 6 August 2026

Excessive sweating, medically known as hyperhidrosis, affects approximately three per cent of the population, yet it remains one of the most underdiagnosed and undertreated conditions in medicine. For those who live with it, hyperhidrosis is far more than a minor inconvenience. It can profoundly impact confidence, social interactions, career choices, and daily quality of life. The good news is that botulinum toxin injections offer a highly effective, well-evidenced treatment that can provide months of relief.

Understanding hyperhidrosis: Beyond sweating

Sweating is a vital physiological process, it’s our body’s primary cooling mechanism. However, in hyperhidrosis, the eccrine sweat glands produce significantly more sweat than is necessary for thermoregulation. This excessive sweating occurs regardless of temperature, physical activity, or emotional state, though stress and anxiety can exacerbate it.

Hyperhidrosis is classified into two types:

• Primary focal hyperhidrosis: The most common form, affecting specific body areas, typically the underarms (axillary), palms (palmar), soles of the feet (plantar), and sometimes the face and scalp. It usually begins in childhood or adolescence and has a genetic component. The cause is thought to be overactivity of the sympathetic nervous system rather than any abnormality in the sweat glands themselves.
• Secondary generalised hyperhidrosis: Excessive sweating caused by an underlying medical condition (such as thyroid disorders, diabetes, menopause, or infections) or medication side effects. This type typically affects larger body areas and has a later onset. Secondary hyperhidrosis requires investigation and treatment of the underlying cause.

If you suspect you have hyperhidrosis, it’s important to discuss this with a medical professional to determine the type and rule out any underlying conditions before pursuing treatment.

How Botox treats excessive sweating

Botulinum toxin type A (commonly known by brand names Botox, Dysport, and Azzalure) works for hyperhidrosis by blocking the nerve signals that stimulate sweat glands. When injected into the affected area, it temporarily prevents the release of acetylcholine, the neurotransmitter responsible for activating sweat production, at the junction between the nerve endings and the sweat glands.

The treatment is most commonly and effectively used for axillary (underarm) hyperhidrosis, where it has been extensively studied and holds regulatory approval in many countries. It can also be used off-label for palmar and plantar hyperhidrosis, though these areas require different techniques and considerations.

The treatment process

For underarm hyperhidrosis, the procedure is relatively straightforward:

1. Assessment: A starch-iodine test may be performed to map the exact area of excessive sweating. This ensures precise treatment.
2. Preparation: The treatment area is cleaned. For underarm treatment, topical anaesthetic is usually sufficient, though ice or cooling devices may also be used.
3. Injection: Using a very fine needle, small quantities of botulinum toxin are injected intradermally (into the skin) at regular intervals across the affected area. Typically, 15 to 20 injection points are used per underarm, with a total dose of 50 units of Botox per side.
4. Duration: The entire procedure takes approximately 20 to 30 minutes for both underarms.

Results typically begin within three to five days, with maximum effect at two weeks. Most patients experience a 75 to 85 per cent reduction in underarm sweating, with effects lasting four to twelve months, averaging around seven months for most patients.

Effectiveness and what the research shows

The evidence base for botulinum toxin in axillary hyperhidrosis is robust. Patient satisfaction rates consistently exceed 90 per cent in published studies.

Importantly, research has also shown that the treatment does not cause compensatory sweating in other body areas, a concern some patients have. While the sweat glands in the treated area are temporarily disabled, the body’s overall thermoregulation is not meaningfully affected, as axillary sweating contributes only a small fraction of total body sweat output.

For palmar hyperhidrosis, botulinum toxin is also effective but treatment is more uncomfortable due to the density of nerve endings in the hands. Nerve blocks or other anaesthetic techniques are often used to manage discomfort. There is also a small, temporary risk of mild hand weakness, as the toxin can affect the small muscles of the hand. This is usually minor and resolves within weeks.

Practical considerations and long-term management

Several practical points are worth considering if you’re thinking about botulinum toxin for hyperhidrosis:

• Treatment frequency: Most patients return for treatment every six to nine months. Some find that with repeated treatments, the intervals gradually extend as the sweat glands become less active over time.
• Cost and access: In some countries, botulinum toxin for severe axillary hyperhidrosis may be available through the NHS or health insurance following failure of topical treatments. Private treatment is also widely available. Discuss your options during consultation.
• Complementary measures: While botulinum toxin addresses the sweating itself, combining treatment with clinical-strength antiperspirants, moisture-wicking fabrics, and stress management techniques can optimise results.
• Alternative treatments: For patients who prefer non-injectable options, alternatives include prescription antiperspirants (aluminium chloride), iontophoresis (electrical current treatment), microwave therapy (miraDry), and in severe cases, surgical options such as endoscopic thoracic sympathectomy. Each has different efficacy profiles, risks, and suitability depending on the type and severity of hyperhidrosis.

If excessive sweating is affecting your quality of life, we encourage you to seek professional assessment. Many patients suffer in silence for years before discovering that effective, well-tolerated treatments are readily available. A clinical team understands the significant impact hyperhidrosis can have and provides compassionate, discreet care.

Frequently asked questions

Is Botox for sweating safe?

Yes, botulinum toxin for axillary hyperhidrosis has an excellent safety profile supported by decades of clinical use and extensive published research. Side effects are typically mild and localised, temporary injection site discomfort, minor bruising, and occasionally a small area of compensatory moisture nearby. Serious adverse events are extremely rare when the treatment is administered by a trained medical professional.

Will I sweat more elsewhere if my underarms are treated?

Compensatory hyperhidrosis (increased sweating in untreated areas) is a well-known concern, particularly associated with surgical treatments for hyperhidrosis. However, with botulinum toxin injections, clinically significant compensatory sweating is uncommon. The temporary, localised nature of the treatment means the body’s overall thermoregulatory capacity is maintained.

How do I know if my sweating is severe enough for treatment?

If excessive sweating interferes with your daily activities, causes emotional distress, leads you to change clothes multiple times daily, affects your work or social life, or fails to respond to over-the-counter antiperspirants, you likely have clinically significant hyperhidrosis that warrants professional assessment. There is no minimum threshold of severity required to seek help, if sweating is affecting your quality of life, treatment is justified.

Can teenagers receive this treatment?

Hyperhidrosis often begins during adolescence and can have a particularly significant impact on young people’s confidence and social development. Botulinum toxin can be considered for teenagers with severe hyperhidrosis, though treatment decisions are made on a case-by-case basis with appropriate parental consent and a thorough discussion of the benefits and risks.

This article is for informational purposes only and does not constitute medical advice. Hyperhidrosis can have underlying medical causes that require investigation. Always consult a qualified medical professional for assessment and treatment. To discuss treatment options for excessive sweating, book a consultation with the clinical team.