Hyperhidrosis - Excessive Sweating

 - Dr. Liz Kelleher, drliz@lkaesthetics.com, (021) 484-3444

Everyone sweats when they get warm, but someone with hyperhidrosis sweats even when it isn’t hot. Basically, there is an abnormal amount of sweating from one part of the body. If you have lived with excessive sweating, you already know that it can be embarrassing. You are always aware of it and try to hide the condition as much as possible. Some call hyperhidrosis the “silent disability.” The condition can wear down a person’s self-confidence and lead to more serious psychological problems.


If you suffer from excessive sweating, you probably dress in layers to cover armpit stains or try to avoid handshaking. This can be a difficult problem for men and women and the most common area treated is the armpit (axillary) area. The good news is that BtxA (Botox and similar drugs) treatments may be helpful.

BtxA has long been known to treat wrinkles. Back in 1993, English doctors proved that injecting BtxA could also slow and prevent hyperhidrosis. Botox is injected into armpits, hands, or feet. As it penetrates the glands, it stops the release of chemicals that lead to perspiration.

There are many positives linked to using Botox as a tool to stop perspiration. Injections take little time, so treatment is fast. The procedure is considered safe and decreases up to 80 percent of sweating.

There are a few negatives associated with using BtxA for sweating. The biggest con is that the results are not permanent. Usually, treatment will last up to eight months. You may experience some pain, especially if the BtxA is being injected into the hands. However, ice and a numbing anesthetic may be applied.

One patient explained that BtxA worked wonderfully for his problems. Since he was young, he struggled with teasing over his sweating that could not be controlled with prescription strength deodorant. After receiving BtxA, he saw immediate positive results.

A real estate agent received BtxA for her clammy hands. She always felt embarrassed when meeting clients. Immediately after treatment, her hands were a bit sore, but the results were amazing. She not longer cringes when it comes to shaking hands.

If you have ever wanted control over a sweating problem, BtxA may be the answer. It is a simple procedure that takes little time to provide great results. Finally, you will be able to face life without anxiety or embarrassment.

FDA Approval and Studies

In 2004, the FDA approved the use of Botox for hyperhidrosis or severe underarm sweating.

Studies conducted by the Saint Louis University School of Medicine have shown that Botox is a safe remedy for excessive sweating, and the long-term data shows that Botox is an effective option for patients who do not respond to prescription creams or antiperspirants.

Patients who endure extreme hyperhidrosis can sweat as much as four times more than normal. Botox treatments have been proven to curtail excessive sweating for up to two years. Four weeks after their initial treatment, some 80 percent of the 193 participants in the study enjoyed a reduction of 75 percent in sweat production. Four or fewer Botox injections were effective for controlling excessive sweating for 94 percent of the participants.

Patients’ quality of life improved after the injections. Before the Botox injections, some 70 percent said their ability to do their job was impaired because of the condition. Only fifteen percent still had issues performing their job after the treatments. Half of the participants said they no longer felt emotionally compromised. Patients also said they were much more comfortable in social settings after the injections.

Hyperhidrosis triggers:

  • exercise
  • heat or cold
  • alcohol,
  • coffee,
  • tea,
  • smoking ,
  • hot or spicy food
  • stress ,
  • anxiety,
  • strong emotions

How to diagnose Hyperhydrosis?

If there is excessive sweating of at least 6 months duration with at least two of the following characteristics then primary Hyperhydrosis is present and this can be treated with Botox.

  1. Bilateral and relatively symmetrical sweating
  2. Impairs daily activity
  3. At least one episode per week
  4. Onset before the age of 25 years
  5. Positive family history
  6. Cessation of sweating during sleep

What can be done?

 The FDA has approved of the use of Botox for treatment of hyperhidrosis. Research and long-term data indicate that the unique chemical structure of Botox can safely and effectively treat excessive sweating. When injected, in small amounts, into the right places, Botox blocks the neurotransmitters that produce sweat and provides remarkable results.

Botox for Hyperhidrosis of the Hands

Palmar hyperhidrosis is an embarrassing condition that can put a significant stress on the social, emotional and professional aspects of life. If you or a loved one is suffering from excessively sweaty palms, you are certainly not alone. In fact, more than a million Americans suffer from hyperhidrosis. In this day and age of rapid medical advancement, living with sweaty palms does not have to be a permanent option.

Botox can substantially decrease sweating by up to 50 percent with each treatment. In many cases, it has stopped sweating completely. It is absolutely safe to use and does not cause any inflammation or irritation. The injections can be easily accommodated within your time schedule. A local anesthetic is administered in order to alleviate any discomfort caused. The tiniest possible needle is used so as to maximize your comfort level during the treatment. Gone are the days when excessive sweating could put a damper on your life. Botox can provide you with desirable and long-lasting results.

Botox for Hyperhydrosis of the Feet

Smelly feet start with sweaty feet (Planar Hyperhidrosis), which can be a problem with embarrassing consequences. It may not be the worst affliction in the world, but if your socks are constantly damp and sweaty, you may have hyperhidrosis.

Do your feet feel soggy and sloppy all the time? Does your sweat ruin your shoes? Are you afraid to wear sandals or flip-flops for fear that you'll slip right out of them?

Do you leave damp footprints when you walk barefoot? Are your feet freezing cold in the winter because they are sweating?

These are just some of the experiences of people with sweaty feet, or plantar hyperhidrosis. Hyperhidrosis, also called excessive sweating, is a medical condition that affects different body areas including the feet. Fortunately, there are treatments available.

Botox injections are a popular treatment choice for underarm excessive sweating (axillary hyperhidrosis) and may be used to manage excessive sweating on the hands and feet as well. You should know, however, that plantar injections of Botox (injections on the foot) can be painful (although there are pain relieving techniques that experienced physicians use) and the results do not last as long as they do in the underarms. Typically, Botox injections in the feet tend to "wear off" in 3 to 4 months, meaning you'll need to return for re-treatment at that point.

To learn more about Planar Hyperhidrosis follow this link to sweathelp.org

Botox for Hyperhydrosis of the Head, Face and Neck

Do beads of sweat pour over your forehead while you're sitting at your desk? Do perspiration rivulets run down your temples during a movie? Has streaming facial sweat gotten in the way of spending time with your family?

If you answered yes to any of these questions, you may suffer from craniofacial hyperhidrosis, or excessive sweating of the face, head, or scalp.

Facial sweating is a common problem and often more irritating and embarrassing than other types of excessive sweating. Even people who sweat heavily in other areas of their body may find that it's their facial sweating that bothers them the most. That's because our faces are how we present ourselves to the rest of the world, and we cannot hide the effects of excessive sweating.

From a diagnostic standpoint, it can be difficult to find the fine line between heavy sweating as a reaction to heat, stress, or exercise and true primary hyperhidrosis of the face and scalp. But regardless of why a person's face sweats excessively — the treatments are the same if it is primary hyperhidrosis.

First, an assessment should be made as to whether a medical condition (other than hyperhidrosis) or medications are the root cause of the excessive facial sweating, which is called secondary hyperhidrosis. It is important to investigate and address underlying causes of the excessive sweating as it may be serious.

If topical antiperspirant solutions don't work or are too irritating,  Botox brand injections may be recommended.  A potential side effect of Botox injections in the face as a treatment for sweating is asymmetry, particularly of the forehead. This can happen if some of the Botox diffuses into the facial muscles. Such asymmetry, however, is always temporary and can, if necessary, be balanced-out by additional Botox injections.

How does it work? - An Underarm example

A small volume of BtxA solution is injected through a very fine gauge needle into the underarm area.  BtxA works by temporarily blocking the chemical signals from the nerves that stimulate the sweat glands. When these glands no longer receive the chemical signals, the excessive underarm sweating stops. The procedure takes about 5-10 minutes, is relatively painless, and the effects of the treatment have been reported to last 6-9 months (Results vary from person to person and eventually will wear off).  Depending on the severity of the hyperhidrosis, multiple injections may be needed.

Within 1-2 weeks of the initial treatment there will be significant reduction in underarm sweating. There is a possibility that some sweat glands may be missed during BtxA hyperhidrosis treatment. If this occurs, underarm sweating may continue from the untreated areas and a touch-up treatment may be needed.

How much does it cost?- Underarm

The cost of BtxA for the treatment of hyperhidrosis can vary widely. The longevity of the procedure depends on the severity of the condition and the number of units of Botox that need to be used. For optimal results, 100 units of BOTOX® (50 units under each arm) is needed. Prices start at €650 at LK Aesthetics. A detailed treatment plan will be laid out in advance so there are no financial surprises once treatment begins.

Pre Treatment Instructions:

  • Shave underarms 24 hours prior to procedure.
  • 2 hours before procedure avoid hot beverages or going to gym (if doing “The Starch Test”).
  • Abstain from use of over-the-counter deodorants or antiperspirants for 24 hours (if doing “The Starch Test”).
  • Do not consume a alcoholic beverages for 24 hours prior to the procedure.
  • Avoid taking Aspirin or Ibuprofen 24 hours prior to the procedure (please check with your Doctor if you take either medication on a daily basis for an existing condition)

The Starch Test:

The “Starch Test” is sometimes performed to view where the affected areas of perspiration are located.  Not all providers perform this test, as it has been said to be  unnecessary.  Most providers inject into the area of hair growth, since sweat glands lie just next to each hair follicle.

Starch Test Info:

Patients should shave underarms and abstain from use of over-the-counter deodorants or antiperspirants for 24 hours prior to the test. Patient should be resting comfortably without exercise, hot drinks, etc for approximately 30 minutes prior to the test.

Here’s what to expect:

Iodine solution will be painted on.

Starch powder will then be sprinkled and allow to settle for 10 minutes.

A blue-black mark will identify affected area of perspiration.

The area will then be circled and marked.

BOTOX® is then injected just beside each pen mark.

Post Treatment Instructions:

  • No deodorant for 12 hours
  • No heavy exercise for 24 hours
  • After Botox injections gently clean and dry your underarm using a mild soap/cleanser.
  • You may begin to experience results within 7 days, full effectiveness is achieved at 14 days.
  • Until the maximum effectiveness of the BOTOX® injection is achieved you can continue to use over the counter antiperspirants.
  • Contact Dr. Kelleher, if you are still experiencing sweating in the treated area after 14 days.

For more information about Hyperhidrosis see http://www.sweathelp.org/en/