Botulinum toxin Botox® for Hyperhidrosis Treatment

Informed Consent

Botox® has been approved for the treatment of severe axillary hyperhidrosis (focal visible excessive sweating of the underarms)

• Of at least 6 months duration in adult and adolescent patients (>12 years of age)
• That has not been adequately controlled by topical aluminium chloride hexahydrate
• With at least two of the following characteristics:
  • Impairs daily activities
  • Frequency of at least one episode per week
  • Age of onset less than 25 years
  • Positive family history
  • Cessation of focal sweating during sleep

Botox is sometimes also used for treatment of hyperhidrosis of the hands, feet, scalp and face although its safety and efficacy have not been established for these indications. Common side effects, associated with the injection include;

• Pain or stinging sensation when the injection is performed.
• Localized swelling, redness, tenderness
• Bleeding at the sites of injection
• Bruising
• Numbness or itching of the area following injection.

The above usually resolve spontaneously within hours or days but may persist for longer. Rare side effects (3-10%) include;

• Compensatory sweating from other areas of the body.
• Aching or weakness in the upper arms, which is temporary
• Infection
• Pharyngitis
• Flu syndrome
• Headache
• Fever
• Anxiety
• Neck or back pain
• Allergic reactions have been reported with this treatment; Symptoms of allergy include; itching, rash, red itchy welts, wheezing, asthma symptoms, dizziness or feeling faint. Get medical help immediately if you have any breathing problems.
• Weakness of hand muscles and drooping of the eye lids may occur in patients who receive BOTOX ® for palmar hyperhidrosis and facial hyperhidrosis, respectively.

I confirm the procedure has been explained to me and that the possible risks and side effects associated with the treatment have been fully discussed and understood. I understand that though complications are uncommon, they do sometimes occur. It is possible that side effects not described may occur and indeed that a complication not previously reported or experienced may occur for the first time.

I have been advised that there are alternatives to this procedure available, including the acceptance of my present condition.

I have had the opportunity to have any questions answered and the time to process and consider the information provided before making a decision to proceed with the agreed treatment plan.

I confirm that I have been provided with verbal and written information about this treatment which includes aftercare and follow up advice.

I confirm that I have used high-potency aluminium-based antiperspirants (equivalent to aluminium chloride hexahydrate) without sufficient benefit or have been intolerant to them.