Sweating is a normal bodily function designed to help us regulate our core temperature. Sometimes, however, the process can get out of control and the body sweats in excess of what is required for normal body temperature regulation – a condition known as hyperhidrosis. 

The problem usually starts during childhood or adolescence and typically affects the underarms, palms or soles. In the first instance, the problem is best managed with a trial of topical agents designed to reduce excessive sweating.  Unfortunately, this often provides inadequate relief for many people and some may decide to proceed with a more invasive treatment such as injections of botulinum toxin (Botox®) or surgery.

The glands which produce sweat are stimulated by nerve branches of the autonomic nervous system. Botulinum toxin works by blocking the transmission of signals from these nerves to the sweat glands and therefore stops the production of sweat. The toxin is delivered to the sweat glands by a series of small injections into the skin. Although the needles used are very fine, the treatment can sting and a local anaesthetic cream is usually used to reduce the discomfort associated with the treatment.

The results of botulinum toxin treatment are usually obvious by 1 week following treatment and generally last between 6-9 months before sweating gradually returns.

Although the treatment is very effective in the majority of patients, up to 5% will not get a satisfactory result. It is also possible that the body may compensate by sweating in excess elsewhere.

If you are one of the unfortunate few people who does not respond to botulinum toxin treatment for hyperhidrosis, surgery to divide the nerves supplying the sweat glands may be the next most appropriate step.