IGeL: Botox against sweating

Botulinum toxin can help against excessive sweating. The health insurance company seldom pays for the treatment. Is it worth the investment?

Botox: The nerve toxin not only tightens loose skin, but can also help against excessive sweating

© W & B / Michelle Günther

What is being done there?

Botulinum toxin ("Botox") is a powerful neurotoxin that can paralyze muscles. It blocks the communication of messenger substances between nerves and muscles, but also with the sweat glands. In the case of excessive sweating (hyperhidrosis), it can be used when other treatments are not effective enough - such as special deodorants with the active ingredient aluminum chloride.

Treatment involves injecting botulinum toxin with a very thin needle near the sweat glands. "This inhibits the transmission of impulses from the nerve fibers to the glands. Less sweat is formed there," explains Professor Dennis von Heimburg, President of the Association of German Aesthetic Plastic Surgeons (VDÄPC). Heavy sweating under the armpits, feet and hands can be treated.


  • If profuse sweating in your hands is causing work-related problems, botox therapy can help you avoid surgery. "That can be useful for pianists, for example," says von Heimburg.
  • Excessive sweating can increase under stress. This is often a vicious circle for those affected. "Botox injections can break this cycle in some patients, so that an improvement can be seen in the long term," says Dr. Marcus Spies, Head of the Clinic for Plastic, Hand and Reconstructive Surgery at the Barmherzige Brüder Hospital in Regensburg.


  • The many injections are uncomfortable to very painful, especially on the hand and foot. That is why mostly numbing creams are used. "You can still feel the treatment with the syringes a bit," says Spies.
  • The effects are not permanent. "Pharmacologically, Botox is only effective for a little over three months, some patients report an effect of up to six months," says von Heimburg.


The treatment takes about 45 to 60 minutes and costs between 400 and over 700 euros. The statutory health insurances only cover the costs in severe cases and if other therapies are out of the question. Those affected almost always have to contribute to the costs themselves.


Botulinum toxin is one treatment option for hyperhidrosis, but it is certainly not the only one. The high costs and the non-permanent effect speak against the therapy.

"Anyone who sweats particularly under the arms should find out about a surgical removal of sweat glands, for example," recommends physician Spies. When feet and hands
areas are severely affected, so-called iontophoresis can help. With this therapy with electricity, health insurers tend to cover the costs.