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Hyperhidrosis: Causes and Treatment of Excessive Sweating

AESTHETIC DERMATOLOGY

Medical content · Specialist Dr. Utkan Kızıltaç • Dermatologist

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What is hyperhidrosis?

Hyperhidrosis is a condition in which the body produces more sweat than is necessary for temperature regulation. A person may experience noticeable sweating even when not in a hot environment or exercising.

The most affected areas are:

  • armpits
  • palms
  • soles of the feet
  • face and scalp

However, excessive sweating can also occur in other areas. (American Academy of Dermatology)

Hyperhidrosis is not just a cosmetic problem. It can significantly affect clothing choices, handshakes, phone or keyboard use, professional life, and social relationships.

Briefly, what you need to know.

  • Normal sweating and hyperhidrosis are not the same thing.
  • Primary hyperhidrosis is usually localized and bilateral.
  • In cases of generalized sweating that starts later in life, other underlying causes may need to be investigated.
  • Underarm and palmar hyperhidrosis are among the most frequently treated areas.
  • Antiperspirants, iontophoresis, botulinum toxin, and some systemic medications are treatment options.
  • Treatment is chosen based on the location and severity of sweating.
  • The effect of botulinum toxin is temporary and can be reapplied if necessary. (American Academy of Dermatology)

What is the difference between primary and secondary hyperhidrosis?

Primary Focal Hyperhidrosis

It usually begins in childhood or young adulthood.

Most frequent:

  • under both armpits,
  • in two palms,
  • on the soles of both feet,
  • face or scalp

Symmetrical sweating occurs. The person may otherwise be healthy. (American Academy of Dermatology)

Secondary Hyperhidrosis

Sweating can be a result of another illness or medication.

For example, some:

  • hormonal/metabolic diseases,
  • infections,
  • neurological conditions,
  • medicines

It can lead to excessive sweating.

Especially in adults, sudden onset of excessive sweating, whether accompanied by night sweats or affecting the entire body, requires an assessment of the underlying cause before resorting to purely cosmetic treatment.

Axillary Hyperhidrosis

Axillary hyperhidrosis is one of the focal hyperhidrosis types that most significantly affects daily life.

Patients typically:

  • constant wetness in clothes,
  • inability to wear colorful clothes,
  • frequent changing of clothes,
  • the effort to conceal sweat stains in social settings

He applies for this reason.

Botulinum toxin is a particularly powerful option here.

How does botulinum toxin work in the armpit?

Botulinum toxin temporarily reduces the release of acetylcholine from nerve endings that stimulate sweat glands.

As a result, sweat production in the treated area is significantly reduced.

Axillary hyperhidrosis is one of the approved medical uses of botulinum toxin in dermatology. (American Academy of Dermatology)

The procedure is performed by injecting numerous small injections into the skin.

The effects usually begin to become noticeable after the first few days and last for months in most patients. AAD has an effect approximately in the armpits and hands. 3–10 months It states that it can last; however, it may vary from person to person.

Palmar Hyperhidrosis

Excessive palm sweating can affect a patient's life much more significantly than we realize.

For example:

  • handshake,
  • holding a pen,
  • using a keyboard or phone,
  • working with paper,
  • using professional equipment

It may get more difficult.

Some patients experience significant discomfort from having wet hands, especially during social contact.

Can botulinum toxin be injected into the palm of the hand?

Yes.

Botulinum toxin is one of the effective treatment options for palmar hyperhidrosis. Iontophoresis is also an important treatment option for the hands. (American Academy of Dermatology)

However, the palm application is different from the armpit application.

Because:

  • Injections may be more painful.,
  • More application points may be needed.,
  • There is a risk of developing temporary hand muscle weakness.

Therefore, the patient's occupation and the importance of hand function should also be considered before treatment.

Is palm application painful?

Because the palms have a high concentration of nerve endings, this method can be more painful than axillary administration.

Therefore, local anesthesia methods or regional anesthesia options may be considered for suitable patients.

Sweating of the Soles of the Feet

Plantar hyperhidrosis:

  • perpetually wet socks,
  • slipping inside the shoe,
  • bad smell,
  • maceration of the foot skin,
  • susceptibility to certain infections

This can lead to problems such as these.

Iontophoresis is one of the important treatments used especially in hand and foot hyperhidrosis.

Botulinum toxin can also be used in plantar hyperhidrosis; however, patient selection is important due to factors such as numerous injections, pain, and duration of effect. (American Academy of Dermatology)

Facial and Scalp Sweating

In some people, the primary source of excessive sweating is:

  • forehead,
  • scalp,
  • face

it could be.

This can be particularly distressing in social situations.

The AAD (American Academy of Dermatology) lists botulinum toxin among the options used by dermatologists for facial hyperhidrosis.

However, due to the muscle anatomy of the facial area, the application plan must be made with particular care. Excessive or incorrectly placed injections can lead to unwanted changes in facial expressions.

Is excessive sweating possible in the genital and groin area?

Yes.

Excessive sweating in the groin, perineal, or genital area can be a significant quality of life problem for some patients.

Is the sensation of sweating actually due to localized hyperhidrosis, or is it:

  • infection,
  • intertrigo,
  • irritation,
  • bromhidrosis,
  • other dermatological problems

It is necessary to first assess whether it exists.

There is literature on the use of botulinum toxin in various indications in the genital/vulvar regions; however, the evidence base for genital hyperhidrosis is not as strong as for axillary or palmar hyperhidrosis.

Therefore, it is considered as an advanced option that can be evaluated in selected patients.

Does Botulinum Toxin Completely Stop Sweating?

The goal is not to stop sweating throughout the entire body.

The treatment reduces sweat production only in the limited area where it is applied.

Reducing the activity of sweat glands in the armpits does not eliminate a person's ability to regulate their body temperature.

Will I start sweating more elsewhere?

The typical compensatory sweating problem seen in surgical sympathectomy after botulinum toxin injection is not a major expected side effect.

Compensatory sweating is particularly important after sympathectomy. The AAD also lists it as one of the most important side effects of sympathectomy. (American Academy of Dermatology)

Are there other treatments for hyperhidrosis?

Yes.

Treatment is tiered according to the area affected and the severity of the condition.

Antiperspirants

Strong antiperspirants containing aluminum salts may be a starting option, especially for milder focal hyperhidrosis.

Iontophoresis

Especially:

  • palm,
  • sole of the foot

It is a well-established treatment for hyperhidrosis.

The hands or feet are held in water through which a low-level electrical current is passed, and repeated applications are used to try to reduce sweating. (American Academy of Dermatology)

Systemic Drugs

Anticholinergic drugs such as oxybutinin or glycopyrolate may be used in some patients.

This can be particularly significant in patients where multiple areas are affected or where local treatments are insufficient.

However:

  • dry mouth,
  • vision problems,
  • constipation,
  • urinary problems,
  • decreased heat tolerance

It is not suitable for everyone due to systemic side effects such as those mentioned above. (American Academy of Dermatology)

Surgical Sympathectomy

Surgery may be an option in selected patients, especially in severe palmar hyperhidrosis.

However, compensatory sweating requires a completely different risk-benefit assessment than local and medical treatments, as it can be a significant and sometimes persistent problem. (American Academy of Dermatology)

Who might be a suitable candidate for Botulinum Toxin Treatment for Hyperhidrosis?

Especially:

  • If underarm sweating significantly affects daily life,
  • If sweaty palms cause occupational or social problems,
  • If local treatments are insufficient,
  • if rapid and regional control is desired

Botulinum toxin can be evaluated.

For areas such as the soles of the feet, the face/scalp, or more specific anatomical regions, treatment is planned on a more individual basis.

How long does the treatment last?

The process itself is usually brief.

The armpit area is generally more comfortable to apply the treatment to than the palms of the hands or soles of the feet.

The effect is not permanent; nerve stimulation of the sweat glands recurs over time.

The treatment can be repeated if necessary.

Frequently Asked Questions

Is Botulinum Toxin Used Only for Cosmetic Purposes?

No. Hyperhidrosis is one of the important dermatological medical uses of botulinum toxin. (American Academy of Dermatology)

Can Botox be injected into the armpits?

Yes. It is a well-evidence-based and approved treatment for axillary hyperhidrosis.

Can Botox be injected into the palms of the hands?

Yes. It can be effective; however, it is evaluated separately from underarm treatment due to different factors such as application pain and temporary muscle weakness.

Can it be done on the sole of the foot?

Yes. It can be used in plantar hyperhidrosis; however, it should be considered in conjunction with other options, including iontophoresis.

Can botulinum toxin be applied to the scalp?

It can be used in selected patients with facial/scalp hyperhidrosis. (American Academy of Dermatology)

Can Botulinum Toxin be Injected into the Genital Area?

There are applications that have been evaluated in specific, selected cases; however, since there is no standard evidence as strong as for axillary and palmar applications in terms of hyperhidrosis, individual assessment is necessary.

Will the sweating completely return?

The effect of botulinum toxin is temporary. Sweating may increase again over time, and the application can be repeated if necessary.

Clinical Note by Dr. Utkan Kızıltaç

The most common areas I see referred for hyperhidrosis patients are the armpits and palms. Botulinum toxin application in these areas can be a very effective option for reducing sweating that significantly impacts daily life. However, sweating is not limited to the armpits; it can also occur on the soles of the feet, face and scalp, and other private areas. For me, the important thing is to first determine whether it's primary focal hyperhidrosis or if there's another underlying cause; then, depending on the area, to choose the appropriate treatment from among antiperspirants, iontophoresis, botulinum toxin, or other options.

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Scientific Resources

  • American Academy of Dermatology — Hyperhidrosis: diagnosis and treatment.
  • American Academy of Dermatology — Botulinum toxin therapy: overview.

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