Dr. De Fazio Plastic Surgeon :: Procedures :: Body :: Hyperhidrosis for feet, hands and all the body



What is Hyperhidrosis?
The term Hyperhidrosis is normally used in medicine to define excessive sweating. Although sweating is a natural process and one of the most important ways of getting excessive heat out of the body, some people tend to sweat much more than necessary to keep a normal body thermoregulation.

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For practical purposes, hyperhidrosis, or excessive sweating, can be of two different sorts:
    * Focal Hyperhidrosis: It is the most common kind of excessive sweating and it normally involves specific areas of our body. In 30-40% of the cases, Focal Hyperhidrosis is localized to the underarms (axillary hyperhidrosis), but it can also affect feet, hands and, more rarely, the face. A specific kind of hyperhidrosis in the face is Gustatory Hyperhidrosis, where excessive sweating is caused by the ingestion of specific kinds of food, normally spicy ones. Botulinum Toxin is an effective treatment against axillary hyperhidrosis.
    * Generalized Hyperhidrosis: it consists of excessive sweating affecting the entire body, normally connected to specific diseases (diabetes, hyperthyroidism) or infections. Generalized Hyperhidrosis is treated in the same ways as the disease causing it and Botulinum Toxin is not used.

Excessive sweating is a problem for about 1% of the population.

The causes of hyperhidrosis are not known with certainty, although it seems to occur more often in people belonging to the same family and, as a consequence, it could imply a genetical influence.
Sweat glands can be activated by different agents, such as:

    * Physical exercise
    * Excessive heat
    * Alcohol, coffee, smoking, spicy food
    * Stress, anxiety, strong emotions
    * Specific times of the day

People who suffer from excessive sweating, tend to produce bigger amounts of sweat in the affected areas (such as the palm of the hands), and to get their clothes wet all the time. This can create uneasiness at work and in social life, even though excessive sweating itself is not giving a bad smell (malodor). Sweat malodor, in fact, is due to the effect of some bacteria acting when sweat is not removed for a long time.


Botulinum Toxin is indicated as a good treatment for axillary hyperhidrosis and hyperhidrosis of the palm of the hands. Botulinum Toxin acts by blocking the nerve endings that trigger the sweat glands. The treatment is quite simple. It consists of injecting the botulinum toxin directly in the axilla (armpit), with 10-15 small injections well spread over the area to be treated. The needles used are very thin; the pain during treatment is very moderate. The effect of Botulinum Toxin will be visible within 7-10 days.

How effective is Botulinum Toxin and how long do the results last?
A clinical study shows that excessive sweating is reduced by 83% one week after the treatment of axillary hyperhidrosis. In the same study, 95% of the patients reported a reduction of excessive sweating by at least 50%.
The treatment of hyperhidrosis with Botulinum Toxin has no permanent effect; the duration is about 4 to 6 months. In order to keep the sweating under control, it is, therefore, necessary to repeat the treatment two or three times per year, according to the individual needs.
If the patients treated decide to stop the treatment, sweating will go back to as it used to be, but there will be no other changes in the treated area.

Contraindications (conditions to withhold the treatment)

Treatment with Botulinum Toxin against Axillary Hyperhidrosis should be avoided if one the following conditions occurs:

    * Allergy to Botulinum Toxin or any of the components
    * Pregnancy or breastfeeding
    * Muscular Diseases
    * Ongoing therapy with neuromuscular blocking drugs
    * Ongoing therapy with any other drugs which could interact with Botulinum Toxin
    * Previous surgery to the axilla (armpit)