title: Palmar and plantar hyperhidrosis: best practice recommendations and special considerations.
abstract: When topical therapy and tap water iontophoresis (TWI) fail, are unavailable, or are deemed unsatisfactory by patients with palmar or plantar hyperhidrosis (HH), the next logical treatment option is botulinum toxin type A (BTX-A). Skill and precision are required to treat palmar and plantar HH because of the dense innervation in the palms and soles. This article describes best practice techniques for BTX-A (Botox), including suggested dilution and syringe selection, injection technique, dose and injection grids, and anesthesia recommendations. In addition, general BTX-A background and special considerations for treating palmar and plantar HH are provided. Insurance reimbursement for treating HH with BTX-A can be challenging; navigating the insurance reimbursement process will be discussed.
authors.affiliation: Department of Dermatology, Saint Louis University, Missouri, USA.
authors.forename: Dee Anna
authors.initials: DA
authors.lastname: Glaser
authors.forename: Adelaide A
authors.initials: AA
authors.lastname: Hebert
authors.forename: David M
authors.initials: DM
authors.lastname: Pariser
authors.forename: Nowell
authors.initials: N
authors.lastname: Solish
mesh_terms: D000465:Algorithms; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D005528:Foot; D006225:Hand; D006801:Humans; D006945:Hyperhidrosis / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D007271:Injections, Intradermal; D007349:Insurance, Health, Reimbursement; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D011788:Quality of Life
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A