Hyperhidrosis (excessive sweating)


Sweating is one of our haemostatic mechanisms to regulate our body temperature. Our body receives signals from the brain to the sweat glands telling us we need ‘cooling’ and this can be triggered by many different stimuli such as the usual thermal or exercise-induced stimuli, in addition to emotional stimuli. Fine manual tasks also trigger our thermoregulatory sweat response and this is normal.

Hyperhidrosis is a disorder when the sweating is out of proportion to the normal regulatory requirements. There is no standardised definition of excessive sweating, although it is diagnosed on a subjective basis when a patient demonstrates a significant affect and interference on their quality of life.

What causes Hyperhidrosis?
Hyperhidrosis can be classified as either primary or secondary, focal or generalised.

Primary Hyperhidrosis:
There is usually no cause found and if this is the case it is thought to be due to a problem with the control of sweating by a part of the nervous system (the sympathetic nervous system), and this is known as ‘primary hyperhidrosis’. The sympathetic nervous system acts as the body’s temperature regulator and sends messages from the brain to your sweat glands to say “produce sweat, we need cooling!” It is thought that in primary hyperhidrosis, there are few too many signals being sent to the sweat glands, even when there is no thermoregulation required.

Secondary Hyperhidrosis:
Secondary hyperhidrosis however, is when a cause has been identified for the excessive sweating… there is a reason for the patient to reactively sweat so much e.g. high BMI, anxiety, stress, being pregnant or post-menopausal, in addition to more organic disease, such as thyroid disease, low blood sugar levels and infection. Of course, certain medications can also cause excessive sweating so you should check with a doctor if it is a side effect of any prescription or over-the-counter medications you are taking. It is also important to note that alcohol, recreational drugs and withdrawing from drugs can also trigger excessive sweating.

Focal vs Generalised Hyperhidrosis:
Focal means the excessive sweating is symmetrical, on both sides, commonly affecting the underarms, soles, palms and face. In contrast, generalised hyperhidrosis is when you experience excessive sweating all over the body.

How can I prevent excessive sweating?
It is important to help your symptoms by lifestyle adjustments initially: losing weight and managing your sleep, ensuring the recommended 8.5 hours of deep sleep is achieved every night. Wearing loose clothes that are not made from synthetic materials. Using regular antiperspirant rather than deodorant; if your regular antiperspirant hasn’t helped then we can prescribe a stronger one to be used at night while sleeping. Avoiding certain foods, drink and drugs that can provoke your sweating response such as spicy food and excessive alcohol. Treating underlying medical triggers such as anxiety with counselling and cognitive behavioural therapy (CBT) that we offer in our psychotherapy clinic (MediMind Clinic).
How can I treat excessive sweating?
If lifestyle changes are in effect and yet still no improvement in your symptoms is seen then we would initially want to rule out any more sinister organic pathology. These include a series of blood tests +/- further investigations that are deemed appropriate from your individualised personal history.

If it truly primary hyperhidrosis, then medical treatment can be targeted at managing the symptoms directly. We can prescribe certain oral or topical medications to help block the sweat-activating hormones.

Alternatively, we can treat with botulinum toxin injections, which have been proven to be a great success in the medical literature and with our patients alike… at the same time we can smooth out any of those facial stress-wrinkles that have imprinted from the distress this sweating has caused you! Please see below for further details on ‘Botulin toxin treatment of hyperhidrosis’.

Lastly, after exhausting all other managements, surgery may be the only option.

Should I worry about my symptoms?
It is usually not harmful and very rarely a more sinister cause is found. This is why we aim to rule out any pathology and secondary causes before treating the symptoms.
Botulin Toxin Treatment of Hyperhidrosis
What will happen when I come to see the doctor?
You will have a consultation with one of the doctor’s in our team where you will discuss your symptoms and concerns. The doctor will take a full medical history and perform a thorough examination. This will also ensure you are safe to carry-out to botulin toxin treatment.

If you decide to proceed with the botulin toxin treatment then the doctor will ask you to sign a consent form and you will move to the medical couch for treatment. We aim to ensure maximum comfort and ease of accessibility during the treatment and you will be asked to lie in a reclining position.

The areas to be treated will be cleaned with antiseptic wipes and the doctor will then mark the areas to be injected to ensure targeted precision. You will then be injected with a very fine needle tip to the areas allocated.

The treatment usually takes 30 minutes for both axillae to be treated (arm-pits). If the client requires anaesthesia, we can apply a topical cream to the skin 30 minutes prior to treatment to numb the area.

How much does the botulin toxin treatment cost?

This usually starts from £300 but depends on the size of the area needed to be treated, the number of areas needed to be treated and the amount of botulin toxin required to manage the symptoms.

Following treatment, what should I do?
Usually there is no immediate difference. You may notice mild redness at site of injection but depending on the individual this should disappear within a few minutes to hours of treatment.

When will I notice a difference?
Patients will start to notice the effects of the botulin toxin within 5-10 days, although it can take up to 14 days to achieve the maximum effect. Not only have studies shown a reduction in sweating symptoms, but also remarkable improvements in their quality of life. Measures include occupational productivity, participating in social activities and emotional well-being.

How long does the treatment last?
Botox treatment is temporary and lasts on average between 3-10 months, but some studies have shown symptom relief for up to 2 years. All patients respond differently and you will know after your first treatment how long the effects last with you.

How long shall I wait before my next treatment?
This depends on what you personally desire, and it is important to bear in mind that duration can vary and is dependent upon your body’s own metabolism, genetics and lifestyle. To ensure optimal maintenance of treatment, a follow up appointment is advised at 3 months for a review and guidance for next treatment.
if I get repeated botulin toxin injections, will I develop resistance to the treatment?
Studies have shown that repeated treatments yield a similar duration of symptom relief, suggesting that ‘tolerance’ or treatment resistance does not develop with botulin toxin treatment.

What are the side effects?
As with any medication it is important to recognise any adverse side effects.
Mild side effects include:
Bruising/ redness/ swelling at site of injection
Mild allergic reaction
Nausea/ headache/ hot flushes
Muscle weakness around injection site
Rarer but more serious side effects include:
Anaphylaxis reaction

Anaphylaxis is a severe potentially life threatening medical emergency caused by an overwhelming allergic reaction. It is characterised by a rapid onset within minutes but can be delayed, presenting after a few hours. Signs and symptoms include an itchy rash (hives, flushing), swelling and redness of the eyes, tingling and swelling in the throat/ tongue and lips, difficulty breathing, chest tightness, racing heart and low blood pressure (can make you feel light-headed).  If you are not in the presence of the doctor when any of the above occurs then you must seek immediate medical attention; if severe and involves airway compromise, call an ambulance on 999).

The other serious side effects usually settle within 1-4 weeks from treatment. Please consult the doctor if any of the serious side effects occur and management options can be discussed.

Who is NOT allowed Botox treatment?
During your pre-treatment consultation, you should thoroughly discuss your medical history with the doctor.

The following are contraindications to botulin toxin treatment:
Acute illness
Infection at proposed injection site
Allergy to any ingredient in the botulin toxin (particularly to toxin or albumin)
Disease of muscle activity (e.g. Myasthenia Gravis, Motor neurone disease)
Bleeding disorders
Use of anticoagulant medication, NSAIDs, steroids and vitamin E (relative contraindication, discuss bruising)
Concomitant use of aminoglycosides (certain antibiotic)

If there are any further questions you want addressing that have not been covered in this section please do not hesitate to ask your doctor during the consultation and we will make every effort to address your needs.