Hyperhidrosis is defined as the excessive secretion of sweat by the eccrine sweat glands, exceeding the amount necessary for the body’s normal thermoregulation. It is a pathological condition in which patients produce an excessive amount of sweat, even while at rest.
Hyperhidrosis affects both genders equally (although women are more likely to seek treatment for the condition) and has a prevalence rate ranging from 0.6% to 2.9%. It typically begins during the second or third decade of life.
Additional studies estimate that in severe episodes, fluid loss can reach up to 3 liters per hour, while normal fluid loss is around 0.5 liters per 24 hours.
Hyperhidrosis, depending on its etiology, is classified as idiopathic (primary) or secondary, and based on the extent of its localization, as focal or generalized. Primary hyperhidrosis is usually focal and affects the underarms, palms, soles, and face. In primary hyperhidrosis, excessive sweating is observed and is attributed to a dysfunction of the autonomic nervous system. It is hereditary in approximately 30–40% of cases and typically begins in childhood. It may persist throughout life or improve over time. Secondary hyperhidrosis may be caused by febrile illnesses, endocrine and metabolic disorders, cardiovascular diseases, malignancies, the use of certain medications, and more. Many patients experience continuous sweating, even during sleep, while others notice sudden and intense episodes of excessive perspiration. Additional contributing factors include stress, emotional tension, high environmental temperatures, and the consumption of stimulating substances (e.g., caffeine, nicotine, alcohol).
- Excessively moist and sweaty skin for prolonged periods
- Unexplained visible sweating even in the absence of heat or high temperatures
- Difficulty performing everyday tasks
- Frequent infections (such as fungal infections)
Hyperhidrosis has serious psychological, social, professional, and financial impacts and significantly affects the quality of life of those affected. Patients struggle to handle tools during manual tasks, hesitate to offer their hand for a handshake, and have limited participation in athletic activities. A high percentage report that the condition negatively affects even their intimate personal moments.
A. For focal hyperhidrosis, the following are recommended:
- General measures (light clothing, cool environment, good hygiene)
- Metallic salts (aluminum hydrochloride – aluminum chloride hexahydrate)
- Topical anticholinergics (glycopyrrolate solution)
- Iontophoresis devices
- Systemic treatment (anticholinergic drugs)
- Use of Laser and Radiofrequency devices
- Local injections of botulinum toxin (e.g., Botox), which may be the best solution for focal axillary hyperhidrosis
- Surgical treatment: removal of sweat glands by skin excision or liposuction (only for the underarm) and thoracoscopic sympathectomy
B. For secondary hyperhidrosis, appropriate tests are conducted to identify and treat the underlying cause.
The action of botulinum toxin used in Botox treatment was approved by the FDA in 2004 for the management of hyperhidrosis. Botox is widely used as a therapeutic agent in various medical applications with proven safety. Botulinum toxin temporarily blocks the nerve signals that stimulate the sweat glands in the treated area. As a result, since the sweat glands no longer receive chemical signals, the symptom of excessive sweating stops. Botox treatment lasts approximately 6 to 9 months and requires maintenance, but after the procedure, the patient can immediately return to daily activities.