Hyperhidrosis treatment with botulinum toxin

For the treatment of

Hyperhidrosis (Excessive sweating)

Commissioning position

This intervention is commissioned for focal hyperhidrosis (axillary/palmar or plantar/craniofacial) if all the following criteria have been met:

  • Hyperhidrosis is not secondary to Generalised Anxiety Disorder
  • self-management strategies have been ineffective
  • topical and oral agents are ineffective or not tolerated
  • Iontophoresis has been ineffective (For palmar or plantar only)
  • symptoms cause significant and frequent disruption to daily life. 

The benefit of treatment is expected to last at least six months, so only a maximum of two treatments per year are commissioned. 

This intervention is not commissioned for generalised excessive sweating. 

Summary of rationale

Botulinum toxin is licensed to treat axillary hyperhidrosis and may also be used for palmar, plantar, and craniofacial hyperhidrosis (treatment is more painful in these areas). The effect may last for 6–9 months. 

References

Scenario: Management | Management | Hyperhidrosis | CKS | NICE

https://bnf.nice.org.uk/drugs/botulinum-toxin-type-a/

Hyperhidrosis (pcds.org.uk)

Associated Pathways

There are no associated pathways.

Specialties

Dermatology York

Places covered by

  • east-riding
  • hull
  • north-east-lincolnshire
  • north-lincolnshire
  • north-yorkshire
  • vale-of-york
Author:
Date created: 11/06/2025, 10:20
Last modified: 26/06/2025, 14:59
Date of review: 2027-10-31