Primary axillary hyperhidrosis
If severe primary axillary hyperhidrosis does not respond to initial treatment (eg with a high concentration aluminium salt antiperspirant), specialist treatment with botulinum toxin A injections is usually the next treatment option.
Botulinum toxin A treatment is effective, safe and well-tolerated. Treatment is repeated once or twice a year, and near or complete anhidrosis is achieved for 6 to 9 months in 80% of patients.
Botulinum toxin A injections are contraindicated in patients with neuropathies or neuromuscular junction diseases, and patients who are pregnant or breastfeedingNawrocki, 2019.
At the time of writing, botulinum toxin A treatments are subsidised by the Pharmaceutical Benefits Scheme and Medicare Benefits Schedule, if prescribed or used by dermatologists, neurologists or paediatricians, for patients older than 12 years with severe primary axillary hyperhidrosis who have failed treatment with topical aluminium salt antiperspirants1.
For primary axillary hyperhidrosis not responsive to botulinum toxin A injections, sweat reduction devices with microwave or ultrasound thermolysis of eccrine sweat glands may be considered. Surgical sympathectomy may be considered as a last resort.