Report: Botox and Texting May Not Mix

Are you a typical American teenager who sends more than 1,000 text messages each month? If so, Botox might impair your communication prowess, suggests a new report of a 17-year-old who had the treatment for a condition that causes excessive sweating.

Doctors who use Botox said they had never heard complaints of texting impairment from patients. But they added it's not entirely unexpected, since the injections have been linked to muscle weakness many times before.

"I would definitely discuss this with my patients going forward as a specific potential side effect," said Dr. Julia Lehman from the Mayo Clinic in Rochester, Minnesota, who treated the teenager.

The case, she told Reuters Health, shows "the importance of thinking about modern-day activities and how our treatments could potentially impair some of these modern-day activities such as texting."

Lehman's patient had a condition called hyperhidrosis, which causes a person to sweat much more than normal -- usually on their palms, the soles of their feet, or under their arms. Doctors aren't sure what causes the condition.

Along with making it difficult for some people to do their jobs and perform other tasks that require dexterity, hyperhidrosis also causes a lot of embarrassment, and keeps many people away from social events, Lehman explained.

Her patient suffered from the excessive sweating on her hands, and had for a few years.
Doctors typically try out prescription antiperspirants in patients with hyperhidrosis as a first treatment strategy. But when the teen didn't get any better, Lehman moved on to one of the next logical treatments: Botox.

Botox is given in tiny injections on the palm and fingers. It contains a chemical that blocks the signal that causes sweat to be released, Lehman explained. But it also relaxes other muscles not related to sweating in the process.

A week after getting the Botox treatment, the patient sweated much less, but her texting skills had decreased as well, Lehman reported in the Archives of Dermatology. The impairment lasted for about six weeks, she said, although the patient didn't need a new Botox injection until several months later.

With Botox, hand weakness "is a known side effect," said Dr. Nowell Solish, a dermatologist on the faculty at the University of Toronto. "We tell everyone, you may get some temporary weakness." But, he added, "It's usually not a significant concern."

He said that around two percent of the U.S. population might have hyperhidrosis, but that many don't realize it's a real medical condition.

Solish, who was not involved in the current study but treats his own patients with Botox, said that hyperhidrosis is a condition that interferes with people's lives to such an extent that most will happily take the weakness trade-off to stop sweating.

Often, he added, doctors performing the procedure can change the Botox dose or their technique if patients have side effects, including texting trouble, the first time around.

Botox treatments for hyperhidrosis have to be repeated every few months, although the time between treatments often increases after patients have had a few rounds of injections, Lehman said.

In addition to worries about muscle weakness, cost may keep patients away from Botox. One San Francisco center that does the procedure for sweaty palms advertises it for $1,200 on its website.

The U.S. Food and Drug Administration has approved Botox for excessive underarm sweating in adults, but says its safety and effectiveness for treating other kinds of sweating hasn't been proven. It also warns on the drug's labeling information that hand muscle weakness can occur when it's used there.

As an alternative to Botox, some patients are treated with a machine that uses electric currents to affect sweat flow, but that can be painful and it also needs to be performed a couple times per week, Solish said.

Surgery to take out the sweat glands or block the signals that trigger sweating is a last resort.
Madu Onwudike, who has researched Botox for hyperhidrosis at Royal Bolton Hospital in the UK, said the treatment isn't his first choice for people with excessive sweating, partially because it's possible that some muscle problems will stick around.

It's unclear whether that would mean long-term texting impairment.

"In my experience the weakness is not permanent but the muscle wasting may be permanent in patients receiving recurrent injections," Onwudike told Reuters Health in an email.

However, "generally patients cope well with the transient weakness and rarely regret the treatment because of this side effect," Onwudike added.

Lehman said that Botox treatments are being used in younger and younger patients, which may require doctors to be in tune with side effects that, like texting, mostly affect that group.