Editing Hyperhidrosis (section)

===Procedures===
Injections of [[botulinum toxin]] type A can be used to block neural control of sweat glands. The effect can last from 3–9 months depending on the site of injections.<ref>{{cite journal |last1=Togel |first1=B |year=2002 |title= Current therapeutic strategies for hyperhidrosis: a review |journal=Eur J Dermatol |volume=12 |issue=3 |pages=219–23 |pmid= 11978559 }}</ref> This use has been approved by the U.S. [[Food and Drug Administration]] (FDA).<ref>{{cite web |url=https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm174949.htm |archive-url=https://web.archive.org/web/20090805030546/http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm174949.htm |url-status=dead |archive-date=August 5, 2009 |title=Information for Healthcare Professionals: OnabotulinumtoxinA (marketed as Botox/Botox Cosmetic), AbobotulinumtoxinA (marketed as Dysport) and RimabotulinumtoxinB (marketed as Myobloc) |publisher=U.S. Food and Drug Administration}}</ref> The duration of the beneficial effect in primary palmar hyperhidrosis has been found to increase with repetition of the injections.<ref name=":0">{{cite journal|title = Commenting on: "Duration of efficacy increases with the repetition of botulinum toxin A injections in primary palmar hyperhidrosis" |doi=10.1016/j.jaad.2014.08.053|volume=72|issue=1|journal=Journal of the American Academy of Dermatology|pages=201|pmid=25497933|vauthors=Comite SL, Smith K|year=2015}}</ref> The Botox injections tend to be painful. Various measures have been tried to minimize the pain, one of which is the application of ice.

This was first demonstrated by Khalaf Bushara and colleagues as the first nonmuscular use of BTX-A in 1993.<ref name="Bushara KO, Park DM. 1437–1438">{{cite journal |last1=Bushara |first1=K O |last2=Park |first2=D M |title=Botulinum toxin and sweating. |journal=Journal of Neurology, Neurosurgery & Psychiatry |date=1 November 1994 |volume=57 |issue=11 |pages=1437–1438 |doi=10.1136/jnnp.57.11.1437 |pmid=7964832 |pmc=1073208 }}</ref> BTX-A has since been approved for the treatment of [[focal hyperhidrosis|severe primary axillary hyperhidrosis]] (excessive underarm sweating of unknown cause), which cannot be managed by topical agents.{{when|date=February 2015}}<ref name="Eisenach JH, Atkinson JL, Fealey RD. 657–666">{{cite journal |last1=Eisenach |first1=John H. |last2=Atkinson |first2=John L.D. |last3=Fealey |first3=Robert D. |title=Hyperhidrosis: Evolving Therapies for a Well-Established Phenomenon |journal=Mayo Clinic Proceedings |date=May 2005 |volume=80 |issue=5 |pages=657–666 |doi=10.4065/80.5.657 |pmid=15887434 |doi-access=free }}</ref><ref>{{cite journal |last1=Felber |first1=Eric S. |title=Botulinum Toxin in Primary Care Medicine |journal=Journal of Osteopathic Medicine |date=October 2006 |volume=106 |issue=10 |pages=609–614 |doi=10.7556/jaoa.2006.106.10.609 |doi-broken-date=2024-11-02 |pmid=17122031 |url=https://www.degruyter.com/document/doi/10.7556/jaoa.2006.106.10.609/html }}</ref>

[[miraDry]], a [[microwave]]-based device, has been tried for excessive underarm perspiration and appears to show promise.<ref name=Ja2013>{{cite journal |last1=Jacob |first1=Carolyn |title=Treatment of hyperhidrosis with microwave technology |journal=Seminars in Cutaneous Medicine and Surgery |date=March 2013 |volume=32 |issue=1 |pages=2–8 |pmid=24049923 |url=https://cdn.mdedge.com/files/s3fs-public/issues/articles/SCMS_Vol_32_No_1_Hyperhidrosis.pdf }}</ref> With this device, rare but serious side effects exist and are reported in the literature, such as paralysis of the upper limbs and [[brachial plexus]].<ref>{{cite journal |last1=Puffer |first1=Ross C. |last2=Bishop |first2=Allen T. |last3=Spinner |first3=Robert J. |last4=Shin |first4=Alexander Y. |title=Bilateral Brachial Plexus Injury After MiraDry Procedure for Axillary Hyperhidrosis |journal=World Neurosurgery |date=April 2019 |volume=124 |pages=370–372 |doi=10.1016/j.wneu.2019.01.093 |pmid=30703585 }}</ref>

Tap water [[iontophoresis]] as a treatment for palmoplantar hyperhidrosis was originally described in the 1950s.<ref>{{cite journal |last1=Kreyden |first1=Oliver P |title=Iontophoresis for palmoplantar hyperhidrosis |journal=Journal of Cosmetic Dermatology |date=December 2004 |volume=3 |issue=4 |pages=211–214 |doi=10.1111/j.1473-2130.2004.00126.x |pmid=17166108 |s2cid=8088671 }}</ref> Studies showed positive results and good safety with tap water iontophoresis.<ref>{{cite journal |last1=Hornberger |first1=John |last2=Grimes |first2=Kevin |last3=Naumann |first3=Markus |last4=Anna Glaser |first4=Dee |last5=Lowe |first5=Nicholas J |last6=Naver |first6=Hans |last7=Ahn |first7=Samuel |last8=Stolman |first8=Lewis P |last9=Multi-Specialty Working Group on the Recognition, Diagnosis, and Treatment of Primary Focal |first9=Hyperhidrosis |title=Recognition, diagnosis, and treatment of primary focal hyperhidrosis |journal=Journal of the American Academy of Dermatology |date=August 2004 |volume=51 |issue=2 |pages=274–286 |doi=10.1016/j.jaad.2003.12.029 |pmid=15280848 }}</ref> One trial found it decreased sweating by about 80%.<ref>{{cite journal |last1=Kurta |first1=Anastasia O. |last2=Glaser |first2=Dee Anna |title=Emerging Nonsurgical Treatments for Hyperhidrosis |journal=Thoracic Surgery Clinics |date=November 2016 |volume=26 |issue=4 |pages=395–402 |doi=10.1016/j.thorsurg.2016.06.003 |pmid=27692197 }}</ref>