Excessive Sweating (Hyperhidrosis)

Hyperhidrosis is a condition in which natural perspiration, the body’s cooling system for regulating its temperature, is considered excessive.  About 1-2% of the population is affected by this condition, and there are many with less severe symptoms who suffer nonetheless.

Excessive sweating can be generalized or found in specific areas of the body, mainly the underarms, palms, and soles of the feet.  This can cause people to feel embarrassed when shaking hands in social or work conditions, and some people need to go home during lunch just to change their shirt.  Often, they report never wearing dark colors, where armpit sweating may be visible.  This sweating can be independent of temperature or emotional state.  For the most part, it is not associated with any odor.  Patients feel a loss of control because they sweat when they are tense, but then become tense because they sweat.  This excessive sweating often starts doing adolescence, which is when many social interactions are initiated, causing the young teenager increased amounts of anxiety.

What are some ways to treat excessive sweating?

Typically, underarm sweating is treated with aluminum chloride deodorants (like drysol), but these are known to cause irritation and not work very well.

Antidepressants can sometimes be used to decrease anxiety related with excessive sweating, but this does not stop the problem itself.

Anticholinergic drugs such as ditropan can be used, but usually have other intolerable side effects like a dry mouth and blurred vision.

Iontophoresis is a treatment used for excessive sweating but it requires daily to weekly sessions to work well, which isn’t practical for most people and is very time consuming.

Surgery where the sympathetic nerves in the chest are destroyed can also be performed by a neurosurgeon, but this has many problems besides the risks of surgery and anesthesia.  Though axillary, or underarm, sweating can be decreased, the surgery can cause a compensatory increase in sweating in other parts of the body.

Botox is now FDA approved for the treatment of axillary hyperhidrosis, and is used off label for treating the palms and soles of the feet.

How does Botox work to stop excessive sweating?

Botox works by temporarily blocking the chemical signals from the nerves that stimulate the sweat glands.  When the sweat glands do not receive the signals, they stop producing sweat.  The results from one treatment typically last from 6-9 months. 

What can I expect during and after the treatment?

First, Dr. Prasad will perform an iodine starch test to look at the area where most of the sweating is occurring.  Then a very fine needle is used to inject small amounts of Botox into the skin, near the sweat glands.  The injections are done in a grid fashion.  Within a week, the amount of perspiration should decrease dramatically.