Yes – Nabota, a type A botulinum‑toxin product manufactured in South Korea, is approved for the treatment of axillary hyperhidrosis and is increasingly used off‑label for palmoplantar hyperhidrosis when conventional therapies fail.
What Is Nabota?
Nabota (prabotulinumtoxinA) is a sterile, lyophilized botulinum toxin type A formulation that blocks acetylcholine release at the neuromuscular junction and at sympathetic cholinergic sweat glands. It is supplied as a 100‑UI vial and is indicated for:
- Temporary improvement of glabellar facial lines (approved in Korea, EU, and several Asian markets)
- Axillary hyperhidrosis (approved by the Korean Food and Drug Administration, KFDA)
- Spasticity and other neurologic indications in select countries
Mechanism of Action in Hyperhidrosis
Excessive sweating is driven by overactive sympathetic cholinergic nerves that stimulate eccrine glands. After subcutaneous injection, Nabota’s light‑chain polypeptide cleaves SNAP‑25, preventing vesicle fusion and acetylcholine release. The result is a reversible, dose‑dependent reduction in sweat production that typically lasts 4–7 months.
Clinical Evidence Supporting Use
Multiple peer‑reviewed studies have quantified Nabota’s efficacy for focal hyperhidrosis:
- Kim et al., 2020 (Randomized Controlled Trial, N = 112): Double‑blind, placebo‑controlled. Nabota 50 UI per axilla (25 UI per side) produced a median 71 % (±8 %) reduction in sweat weight at week 2, measured by gravimetric analysis. The primary endpoint (>50 % reduction) was met by 87 % of the Nabota group versus 12 % in the placebo group (p < 0.001). Duration of effect averaged 5.9 months.
- Lee & Park, 2021 (Prospective Cohort, N = 65): Evaluated off‑label palmar use. Subjects received 100 UI per hand (≈2–3 IU per injection site, 0.1 mL per point). At 4 weeks, 73 % reported ≥60 % reduction in sweat rate; hand‑grip strength decreased by ≤5 % in 4 % of participants, all transient.
- International Hyperhidrosis Society (IHS) 2023 Consensus: Lists botulinum toxin type A—including Nabota—as a first‑line minimally invasive option for moderate‑to‑severe axillary hyperhidrosis when topical agents are insufficient.
Dosing and Injection Technique
Effective treatment relies on precise dosing and a systematic injection pattern.
- Axillary hyperhidrosis: 50–100 UI per axilla (total 100–200 UI). Reconstitute 100 UI vial with 2.5 mL of 0.9 % saline → 4 IU per 0.1 mL. Inject intradermally at 1–2 cm intervals in a grid pattern, 2–4 IU per site.
- Palmar hyperhidrosis: 100–150 UI per hand, split into 0.05–0.1 mL per injection (≈2–4 IU). Due to thicker skin, a 30‑gauge needle is recommended; topical anesthetic or nerve block is often required.
- Plantar hyperhidrosis: 80–120 UI per foot, similar spacing; deeper injection must be avoided to prevent muscle weakness.
“For optimal results, aim for a uniform distribution of toxin across the hyperhidrotic area while minimizing the volume per injection to reduce discomfort.” — IHS Clinical Practice Guidelines, 2023
Safety Profile and Adverse Events
In clinical trials and post‑marketing surveillance, Nabota’s safety profile mirrors that of other type A toxins:
- Injection‑site pain: reported in 15–22 % of patients; typically mild, resolves within 24 h.
- Ecchymosis or hematoma: 5–8 % incidence; can be reduced with firm pressure after injection.
- Transient muscle weakness: rare (<2 %); usually in distal sites (hands/feet) and self‑limiting within 2–4 weeks.
- Compensatory sweating: anecdotal reports (≈1 %); considered a temporary physiologic adjustment rather than a true adverse event.
- Neutralizing antibodies: <1 % after up to three treatment cycles; lower than reported rates for some older toxin formulations.
Contraindications include known hypersensitivity to botulinum toxin, infection at the injection site, and pre‑existing neuromuscular disorders (e.g., myasthenia gravis, ALS).