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Botox Treatment for Palmar and Plantar Hyperhidrosis
Written by Katie Crissman
October 01 2020

For people who suffer from hyperhidrosis that affects their palms and the soles of their feet, botulinum injections, or botox for short, can provide significant relief from symptoms. Botox injections work best for those who have primary focal hyperhidrosis (sweating in localized, specific areas). This article goes into detail for those who need to know about botox as a treatment for sweaty hands and and as a treatment for sweaty feet. The type of sweat glands that allow the body to sweat are called eccrine gland and they are numerous. Sweat glands cover the entire body, but are especially prevalent on the palms and the soles of your feet. People with primary focal hyperhidrosis have normal sweat glands that are dispersed in the same density as non-affected people, but their sweat glands are overactive in specific areas, so they experience excessive sweating. This is why a localized treatment like botox injections can be so helpful.[1]

Botulinum toxin is a type of neurotoxin produced by a bacteria called Clostridium botulinum which can cause paralysis in humans. Historically, botox has been used in cosmetic procedures to reduce the appearance of wrinkles. However, in recent years this toxin has been utilized in many medical treatments and has been found especially effective for managing the sweat caused by primary focal hyperhidrosis. One study published in the journal of Neurology found that botox injections were effective in eliminating hyperhidrosis symptoms in all its participants for two months after receiving injections. It also showed that the results of botox remained effective in most patients after six months.[2] Studies like this show that botox is a viable treatment for those suffering from palmar and plantar hyperhidrosis who have not had success managing hyperhidrosis at home and in whom over the counter topical treatments have not been effective. Botox injections are typically a second line treatment and patients should see if more conservative treatments are effective when before trying them. First line treatments often don’t provide enough relief for many suffering from hyperhidrosis. For these people, botox injections are an excellent method of reducing symptoms and improving quality of life. Most patients who initiate treatment are motivated to stick with it due to its effectiveness and lack of adverse effects.[1] Currently, botox injections are used off-label for the treatment of palmar and plantar hyperhidrosis, but are FDA approved for use in axillary hyperhidrosis.[4]

How Botox for Palmar and Plantar Hyperhidrosis Works

Botox is approved by the FDA for the treatment of axillary hyperhidrosis, but doctors have found that it is also an effective treatment for palmar and plantar hyperhidrosis. However, botox is not currently FDA approved for use in the hands and feet. The procedure is similar for all three areas of the body, but varies slightly based on the location in which injections are administered. Before patients are given botox treatment they are evaluated to see severe their sweating is. This can be done in several ways including through the use of an evaporimeter, persprint paper, patient reports, and most commonly, the iodine starch test.[1]

There are four brands of botox formulations that are approved for use in the United States and each one works slightly differently. When injected, all botulinum toxins block the release of acetylcholine and various other neurotransmitters which prevent the eccrine glands (sweat glands) from producing sweat which alleviates hyperhidrosis symptoms. The injections are placed directly into the affected areas of the palms or soles.[1]

Before botox treatment is stated an iodine-starch test may be performed to determine the area of the palm or sole that requires treatment. A povidone-iodine solution is painted onto the affected area and then cornstarch is added. When a patient begins to sweat the mixture highlights the moistened areas by forming dark marks where sweat is collecting, thereby letting the practitioner know where the problem areas are.[4] A grid is then marked on the hand or foot that is going to be treated, indicating where the injections will be placed.[1]

Prior to beginning injections patients are given some type of pain management. Typically, a regional nerve block is placed so that a patient will temporarily lose sensation of the palm or foot. This is done with an injection and blocks sensations from the local nerves. Other types of pain control are sometimes used such as needle-free anesthesia, ice, skin-cooling devices, vibrational analgesia or pocketed microneedles.[1]

The botox formulation is then injected into the skin of the palms or soles of the feet where the marks indicate. The skin of the palms and soles can be particularly thick, so multiple needles may be used. The type of botulinum formula that is used is variable and depends on the doctor. Treatments usually need to be repeated once every six months.[1]

After receiving treatment, patients are monitored to make sure that the procedure was successful and to ensure that no significant side effects occur. This begins in the doctor’s office directly after the procedure and continues for the next few weeks. Most patients experience relief from symptoms within 7 to 10 days of getting botox injections. Doctors will typically call a patient after two weeks to confirm that it their procedure was effective.[1]

Adverse Effects

The most common side effect of palmar and plantar botulinum injections are immediate pain and bruising at the injection site. Injections in the palm can sometimes cause weakness in the muscles of the hand and atrophy of muscles. This is fairly common. Other complications can arise from the regional nerve block and can include neuropathy, impaired hand dexterity, and other potential issues. A nerve block to the wrist, which is frequently used as a pain control method for patients getting botox, can also lead to some immediate side effects. Most notably, a condition called reactive hyperemia, in which oozing occurs at each injection site can occur as a result. There are very few cases of patients developing a hematoma, swelling from clotted blood under the skin, although it can happen. In general, botox is thought of as a fairly safe treatment for hyperhidrosis. Most patients who fail to continue treatment are thought to do so because of pain and because of the fact that it can feel invasive.[1]

When Botox Should Not be Used

There are some situations in which botox injections should not be considered as a treatment option. Botox is considered a category C medication for pregnant women and so should be avoided during pregnancy and nursing. It is important to make sure a patient is not allergic to botulinum toxin before treatment can be initiated. There are also certain medications that can impact the metabolism of botulinum and make it unsafe to use.[1]

While people usually don’t experience any serious side effects from getting botox injections, for those in careers that require fine hand movement and strength doctors tend to be especially careful. Botox is still recommended for people in this situation, but doctors suggest getting botox injected into a person’s non dominant hand first to make sure that no complications occur. Once a person knows they can safely receive injections in their non dominant hand their dominant hand can be treated at a later visit.[1]

For those who are struggling to find successful treatment for sweaty hands or treatment for sweaty feet botulinum injections may be the right next step in your journey to conquering hyperhidrosis. It is less invasive than surgical treatments for primary focal hyperhidrosis and has been shown to be very effective treatment modality.

  1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Amsterdam: Elsevier Pub. Co., 2014. Retrieved
  2. Saadia, D., Voustianiouk, A., Wang, A. K., & Kaufman, H. (2001). Botulinum toxin type A in primary palmar hyperhidrosis Randomized, single-blind, two-dose study. Neurology, 57(11). doi:
  3. Doft, M. A., Hardy, K. L., & Ascherman, J. A. (2012). Treatment of Hyperhidrosis with Botulinum Toxin. Aesthetic Surgery Journal, 32(2), 238-244. Retrieved July 29, 2018, from
  4. Walling, H. W., & Swick, B. L. (2011). Treatment Options for Hyperhidrosis. American Journal of Clinical Dermatology, 12(5), 285-295. Retrieved July 27, 2018, from

What You Need to Know About Carpe Clinical Regimen

By Katie Crissman /

One of the newest clinical strength antiperspirants to hit the market is Carpe’s Clinical Grade Regimen - it combines several high performing products with a specific care routine to provide long term sweat reduction for even the heaviest sweaters. Read on to see if Carpe Clinical Regimen is right for you!

Antiperspirant is great - for most people. You apply it once a day and it stops your sweat! It’s easy. But, what if that’s not what happened? You bought it, read the label, and used it exactly as directed and, unfortunately, you’re still sweating - excessively. If this is you, then you’ve come to the right place. There are products specifically made for heavy sweaters who haven’t had luck with traditional antiperspirants. These products typically include the words “extra strength”, “clinical strength” or “prescription strength” and they are, thankfully, available over the counter without a doctor’s prescription. 

The difference between clinical strength products and their weaker counterparts are the active ingredients they use. Clinical strength lines typically use one of several newer types of metallic salt ingredients that are known to be both stronger and less irritating than aluminum chloride (which is the standard active ingredient in antiperspirants) [1]. While there are many clinical strength products on the market, we are going to focus on a new clinical strength regimen that combines a strong active ingredient with a specific care routine to get excessive sweating under control. 

Carpe Clinical Regimen -  What It Is and How It’s Different

One of the newest clinical strength antiperspirants to hit the market is Carpe’s Clinical Grade Regimen. It’s different from other prescription grade products because it combines several strong products with a specific care routine to ensure maximum product performance. It’s also different from Carpe’s other products because it uses a stronger active ingredient and delivery system. The system is geared toward people who experience intractable armpit sweating, but Carpe also makes products for people who struggle with other types of sweat. The Carpe Clinical Grade Underarm includes three specific products that, when used together, have been found to be highly effective at reducing sweat production. These products include:

  • Carpe Clinical Grade Underarm Antiperspirant 
  • Carpe Clinical Grade Exfoliating Wash
  • Carpe Clinical Grade Underarm Wipes[2]

Carpe Clinical Grade Regimen uses an active ingredient called Aluminum Zirconium Tetrachlorohydrex GLY (20%) combined with other soothing inactive ingredients to effectively stop sweat in its tracks while reducing skin irritation.[3] Aluminum Zirconium Tetrachlorohydrex is a newer generation metallic salt that stops sweat production and is known to be more effective than other types of active ingredients antiperspirants typically use. One study mentioned in the journal Dermatologic Clinics found that antiperspirants using Aluminum Zirconium Tetrachlorohydrex were, on average, 34% more effective than antiperspirants that used aluminum chloride as an active ingredient.[1] Carpe’s traditional products use an active ingredient called Aluminum Sesquichlorohydrate at 15% which is effective, but less potent than Aluminum Zirconium Tetrachlorohydrex.[4]

It’s important to note that Carpe’s Clinical Grade Regimen provides a long term impact on sweat reduction from making short term lifestyle changes. This is because the results build up over time and peak at about 4 weeks. It takes 4 weeks of using the Carpe clinical grade products once each morning and every other night to see the full effect of what they can do. This is typical of all antiperspirants as their effects tend to build up with consistent use. Consistently using antiperspirant products is especially important for those with hard to treat sweat problems because it can be the difference between treatment success or failure.[1][2] 

If you’re frustrated with the way your current antiperspirant is working or how it isn’t working, then consider giving Carpe’s Clinical Grade Regimen a try! It’s active ingredient is comparable to other prescription strength products on the market but it’s multistep system with easy to use wipes is completely unique! Remember, an easy to use, consistent antiperspirant routine is going to give you long term sweat reduction so it’s important to find a system that works for your lifestyle. 

  1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Amsterdam: Elsevier Pub. Co., 2014. Retrieved from>
  2. How It Works (Clinical). Carpe.
  3. Clinical Underarm  PM Wipes. Carpe.
  4. Underarm Antiperspirant for Excessive Underarm Sweating. Carpe.
Body Areas Affected by Hyperhidrosis

9 Outrageous Things People Try to Avoid Excessive Armpit Sweating

By Daniel McCarthy /

9 Outrageous Things People Try to Avoid Excessive Armpit Sweating

On my first day of work a few years ago, I got dressed to impress and walked the 20 minutes to my new office to meet my new colleagues for the first time. Having just moved to the southern US, I’d been getting used to the unbearable humidity and its effects on my excessive armpit sweating. Luckily (I thought), the sun wasn’t out and the temps dropped below 80, so maybe my sweat glands wouldn’t take center stage! Well...I arrived to meet my colleagues looking like a wet bass in business clothes. Thank goodness I arrived 15 minutes early, which brings me to the first outrageous thing people try to avoid armpit sweating. 

  1. The Hand Dryer 

I anxiously scurried to the nearest bathroom, declothed, and put the hand dryer to good use on my shirt stains and sweat stains. More outrageously, I awkwardly hovered my sweaty extremities (including my sweaty underarms) over the hand dryer. Thankfully, I reapplied my antiperspirant and headed out to meet my colleagues a decently dry man. That was the day I knew I really needed clinical strength antiperspirant for my excessive armpit sweating (and a car). 

  1. Pantyliners

Many with excessive underarm sweating already know that underarm pads are one way to help with sweating armpits. But if you find yourself sans pad and worried about your excessive armpit sweating, you would not be the first person to try pantyliners. That’s right, pantyliners have been used in a pinch to help keep sweat stains at bay. 

  1. Give a shirt

In 2019, a reddit user posted that to combat his excessive armpit sweating, he skipped the typical clothing and made his own shirt. He posted asking others to try out his creation and received over 250 replies! By creating and giving others shirts, this innovative reddit user designed his way into the hearts of many with smelly armpits. 

  1. Get inked

If you’ve been debating whether to get a tasteful tattoo and you have hyperhidrosis, this finding may just help you make your decision. A 2017 study found that getting inked helped reduce sweat [1]! Now, I don’t recommend choosing a tattoo as a means of treatment for excessive armpit sweating (and maybe don’t tattoo your armpit), but the connection is a fun little fact nonetheless. 

  1. Become a naked mole rat

If you can’t pull the trigger on an armpit tattoo, another method some people have tried is hair removal. Yes, like Steve Carrell (who actually has hyperhidrosis himself) in the hit movie 40-year Old Virgin, removing hair can help reduce sweat buildup for you too. Many likely already “naturally” lose hair thanks to some sweat prevention products, but more natural hair removal may just be the trick to solving excessive sweating

  1. Armpit art

Even though we know most sweaty armpit causes, like too much caffeine or spicy foods, it’s no fun to cut these out completely. A more outrageous approach to excessive underarm sweating is actually turning sweating armpits into art. Multiple users of the Reddit community r/Hyperhidrosis have created shirts, sweatshirts, and other clothing that includes beautiful tie-dye in the armpits. Creative, fun, and beautiful, and even better when combined with sweat prevention like antiperspirant or carpe underarm

  1. Vinegar your armpit

You may already know how to get rid of pit stains with vinegar, but there are other interesting ways it can help with excessive armpit sweating. Splashing vinegar on your sweaty underarms  is one method many recommend. Those that swear by this method also recommend using deodorant or antiperspirant, too. 

While we don’t know how this was discovered, I like to think someone accidentally splashed vinegar on their pits hundreds of years ago and voila! Too bad the first person to splash his pits with vinegar didn’t also have access to the best antiperspirant for his excessive armpit sweating. 

  1. Baking soda your sweaty underarms

If you find deodorant or antiperspirant irritating, one creative way to help alleviate your excessive underarm sweating is baking soda. Many crafty people with hyperhidrosis swear that not only can baking soda help reduce sweat, but it can also help alleviate pesky underarm smell with some of the best sweat prevention. 

  1. Restart the plaid fad

Black t-shirt, black sweatshirt, black button down, black tank top. If this sounds like your closet, you’re clearly an expert on the hyperhidrosis wardrobe. But if you want some variety as you fight excessive armpit sweating, add some plaid, a trick many with hyperhidrosis use that you may not know. Hey, you just may be starting the resurgence of the plaid fad, and at worst, you’ll add some fun, lumberjack variety to your dark closet. 


[1] Luetkemeier, M. J., Hanisko, J. M., & Aho, K. M. (2017). Skin Tattoos Alter Sweat Rate and Na+ Concentration. Medicine and science in sports and exercise, 49(7), 1432–1436.
Body Areas Affected by Hyperhidrosis

How to Cure Sweaty Hands Permanently at Home

By Daniel McCarthy /

How to Cure Sweaty Hands Permanently at Home 

Scenario 1: You’re invited into the office, confident you will land the job. You’ve prepared, you’re highly qualified, you have absolutely nothing to worry about. You walk in and confidently reach out to shake the CEOs hand. But then, your confidence turns to dread as the CEO pulls her hand back, wet with your sweat. 

Scenario 2: You’re at home, playing video games with your friends and absolutely dominating. They get so upset, they tell you to take a break to let another friend play. But there’s another problem... nobody wants to use your controller after you finish. Despite your domination, your palmar hyperhidrosis (excessively sweaty hands) has taken center stage. 

Do these scenarios sound familiar? Wondering how to cure sweaty hands permanently? Although you may not have had these exact things happen to you, your sweaty hands likely have caused something similar and you’re looking for a home remedy. To stop sweating these situations, let’s talk about how to cure sweaty hands permanently at home. 

One of the best ways to cure sweaty hands at home is actually not related to the hands at all. Instead, working on reducing anxiety can have immensely positive results on how to cure sweaty hands permanently naturally. There are many root causes of anxiety, and some or many may be related to your hyperhidrosis. Likewise, it is easier said than done to reduce anxiety. But there are also many ways to work on reducing anxiety that are worth a try. One interesting way to reduce anxiety, and in turn, sweaty hands, is to be grateful. Specifically, Petrocchi and Couyoumdjian found that “grateful people experience less anxiety mostly because they are able to encourage and be compassionate and reassuring toward themselves when things go wrong in life” [1]. Other ways include stepping outside for a walk, drinking tea, or even distracting yourself. In general, starting with anxiety reduction not only can help with how to cure sweaty hands, but also your wellbeing in general. 

Another great way to cure sweaty hands at home permanently is to reduce consumption of coffee and alcohol. Now you may be reading this and thinking “Hey, those are all my favorite things! I’m done with this article!”. And while I wholeheartedly agree and enjoy coffee and alcohol myself, consumption in moderation is key, especially with hyperhidrosis. Caffeine, for example, activates part of the brain that is already a main part in causing hyperhidrosis symptoms. Instead of giving it up, try to reduce consumption to under 200 mg or add in decaf to your routine. Alcohol can affect hyperhidrosis in a similar manner, but like coffee, 1-2 glasses of alcohol may be okay. When figuring out how to cure sweaty hands permanently naturally, it is important to find a balance of coffee, alcohol, and managing your hyperhidrosis. And remember to always drink responsibly, in moderation. 

Tackling how to cure sweaty hands permanently, naturally, and at home may require more than behavioral changes we’ve talked about so far. Luckily, there are other great remedies you can try at home! First, finding the right antiperspirant is of paramount importance, especially appropriate antiperspirant for hands. Another possible over the counter option is anti-sweat wipes. If neither of these work for you, another option to cure your sweaty hands permanently is to buy your very own iontophoresis machine for at-home use. This machine delivers mild electrical currents to your hands (or other affected body part) while submerged in water. A combination of these treatments may have your hands feeling less clammy in no time! 

Ultimately, your palmar hyperhidrosis may not be treatable at home and permanently, but these recommendations may help alleviate some of your symptoms. If symptoms persist, consult a medical professional for further assistance with how to cure sweaty hands. 



1. Nicola Petrocchi & Alessandro Couyoumdjian (2016) The impact of gratitude on depression and anxiety: the mediating role of criticizing, attacking, and reassuring the self, Self and Identity, 15:2, 191-205, DOI: 10.1080/15298868.2015.1095794

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