Dermatologists may use Botox to help treat HS due to the injection’s ability to reduce sweat production and decrease inflammation. However, more research is needed to confirm its effectiveness.

Hidradenitis Suppurativa (HS) is a chronic skin condition characterized by inflamed, painful nodules that form in areas of the body with sweat glands where skin rubs together, such as the armpits and groin.

Since Botox has been widely used in the treatment of sweat gland disorders, such as hyperhidrosis, some theorize that the injectable can be used to treat HS, too.

Although some medical professionals already administer Botox as a treatment for HS, there’s limited evidence to support its effectiveness. Here’s what to know.

There’s not yet a cure for HS, but ways exist to help manage the condition. Most of the time, treatment for HS involves an antibiotic, like clindamycin or oral doxycycline, to reduce the pus-filled abscesses and reduce the infection.

More recently, two anti-inflammatory agents, adalimumab and secukinumab, have also been FDA-approved for the treatment of HS.

The chemical agent resorcinol may also be used to clear clogged hair follicles and reduce inflammation.

Dermatologists may also prescribe medication like corticosteroids or recommend in-office treatments like laser hair reduction or Botox injections to help treat HS.

Though the FDA hasn’t yet approved Botox as a treatment for HS, it has been approved for excessive sweating. Reducing sweat may, in turn, reduce the rate and severity of skin infections.

It’s suggested that reduced sweating may affect the microbiome and decrease bacterial overgrowth. Research also indicates that Botox could potentially decrease neurogenic inflammation.

According to Dermatologist Ahmad Chaudhry, the ability of Botox to reduce sweat production helps manage HS symptoms in some patients.

Still, Chaudhry noted that Botox “is not a first-line treatment because of its cost and because the benefits are typically temporary.” There is also a lack of literature demonstrating the effectiveness of using Botox, which currently hinders its consideration as a first-line treatment.

If receiving Botox as a treatment, patients can expect to repeat treatments at least a few times a year to maintain results.

Keep in mind that there are also risks with getting Botox, including discomfort and the potential for muscle weakness at the injection site, Chaudhry explained.

Ideally, Botox might help with:

  • flare-up reduction
  • wound healing
  • pain relief
  • prevention from worsening sores

But there’s not enough research to know for sure.

Since the research is fairly mixed, more studies are needed to determine how effective Botox can be for treating HS symptoms.

A 2022 literature review indicates limited clinical evidence exists to support the effectiveness and safety of Botox for HS. One randomized control trial revealed a statistically significant, meaningful difference in HS outcomes with the use of Botox. However, scientists found that the remaining evidence is mostly anecdotal or consists of very small studies.

However, a 2022 review suggests that Botox injections either led to clinical improvements or improved quality of life in 96.8% of patients studied. The evidence level was moderate, leading experts to conclude that Botox is a safe and potentially effective alternative treatment for HS.

In a small, placebo-controlled 2020 study, researchers concluded that Botox injections reduced the number of lesions and improved quality of life in 20 patients with HS. Researchers also found a suggested comorbidity between HS and the sweat gland disorder hyperhidrosis. Since Botox is commonly used and FDA-approved to treat hyperhidrosis, this finding is promising.

According to a 2020 review, Botox can be an effective therapy in patients with HS, especially when the patient also has hyperhidrosis or traditional therapies fail.

Researchers noted that patients will likely need multiple treatments over time since lesions tend to reemerge after 6 to 10 months. Scientists note that more research is needed to understand the role of Botox in managing HS, including the best dose and how often to administer it.

Side effects associated with using Botox in general include:

  • allergic reactions
  • muscle weakness
  • flu-like symptoms like nausea or aches
  • risk of toxins spreading

Those that also have the common comorbid condition axillary hyperhidrosis in addition to HS may also experience:

  • bleeding or soreness at the injection site
  • sweating elsewhere on the body
  • headache
  • back or neck pain
  • itchiness

Mild injection site reactions (like swelling) should emerge within a week and resolve within a few days. If you experience any side effects — especially prolonged ones (longer than 2 to 3 days), talk with your doctor.

Botox may be an effective treatment for HS, but more research is needed to know for sure. For now, evidence seems to suggest Botox injections can help decrease excess sweating and curb the inflammation associated with HS lesions.

Though Botox isn’t a first-line treatment for HS, your doctor may recommend it as an additional measure or when other methods fail.

Chaudhry’s advice for patients with HS is to “try not to get discouraged. HS management can be a journey of trial and error to find what works best for you.”

He encourages patients to stay in touch with their healthcare professional “and remember that it’s perfectly OK to seek a second opinion if you feel like your current treatment plan isn’t working for you.”