Botox® is the commercial name given to a toxin which is produced from botulism toxin. It blocks the chemical transmitter that causes sweating. It is used mainly on isolated cases of armpit sweating. The injection of the Botox® in the armpit areas can help the patient for about 3 to 6 months at a time. Some people try to use it to treat palmar hyperhidrosis but it is less effective and very painful. Also it was attempted to be used for the treatment of plantar hyperhidrosis (foot) with extremely low success rates. So far at present Botox® is not FDA approved for the treatment of palmar hyperhidrosis or excessive hand sweating. Some of the insurance companies require Botox injections as a pre-requisite for their approval of ETS. Patients can contest this requirement however results vary depending on their carrier on a case by case basis. If an insurance company is still demanding a trial of Botox they should be responsible for the cost associated with this treatment.