Excessive sweating or hyperhidrosis is a hereditary trait that affects 1% of the population. It is an unpleasant condition, which can have a negative impact on the professional, social and personal life of those affected. Aside from increasing body odor, clothing stains very easily, which can also cause unnecessary expense.

The modern solution is the use of botulinum toxin (Bocouture®, Dysport®, Azzalure®, Vistabel®), a prescription medication that, injected by an experienced and properly trained physician, can dramatically reduce excess sweating. Botulinum toxin is a naturally purified protein that works by blocking the secretion of acetylcholine in the nerves connected to the sweat glands.

Causes of excessive sweating

Hyperhidrosis is caused by abnormal activity of the eccrine sweat glands in the skin. Eccrine glands are found in the skin, in various concentrations, depending on the area. They are found mainly on the palms of the hands, the soles of the feet and the armpits, in a total of about 2-4 million glands per person. Its function is to keep body temperature stable in cases of ambient heat or increased physical activity.

Sweat evaporates on the skin causing a heat exchange between the blood in the outer skin vessels. This means that the blood cools when it passes close to the surface of the skin, contributing to a drop in body temperature.

Sweating can be measured in litres per hour

Although the glands are normal, in cases of hyperhidrosis they are affected by excessive stimulation by the nerves of the central nervous system, located in the hypothalamus. Surrounding the sweat glands are myoepithelial (muscle) cells that can contract when stimulated by sympathetic nerves. When contracting, the sweat is expelled to the outside through the pores. These nerves use acetylcholine (a neurotrasmitter substance) to stimulate cells. This is where botulinum toxin treatment works, as by blocking the realease of acetylcholine, the sweat glands are unable to expel sweat.

Traditional hyperhidrosis treatments

Treatment options for hyperhidrosis include aluminum chlorides in deodorant formulas, iontophoresis, and medications such as glycopyrrolate or clonidine. Topical treatment has limited success, while medications can give unpleasant side effects such as dry mouth and visual disturbances, as well as limited efficacy on hyperhidrosis.

Surgical options are direct removalg of the affected skin or sympathectomy, which involves cutting the nerves that control sweating. Surgery has a range of possible serious complications, such as pulmonary perforation (pneumothorax), Horner syndrome, damage to adjacent nerves, or visible scarring that limits movement and leads to prolonged recovery.

Hyperhidrosis treatment with botulinum toxin

To diagnose and determine the area affected by hyperhidrosis, a painless and non-invase starch-iodine test is performed. Once the test has been carried out, the medication is injected with a sterile single-use syringe, using a very fine needle. The injections are intradermal, and are distributed evenly over the affected area.

It is a quick, simple and effective procedure. After about 48 hours, most patients notice a reduction in sweating that can last 3-6 months. In some cases, optimal results can last up to a year.

Risks and side-effects

The treatment uses an exclusive prescription medication, therefore it can only be prescribed by a doctor. The injections must be administered by a doctor with experience and accredited training.

Patients with neuromuscular transmission pathologies, glaucoma, infections, nursing and pregnant mothers, among other medical conditions, are not good candidates for treatment.
Possible side effects: bruising in the injected area, inflammation, allergy to medication, infection, peripheral muscle involvement, due to accidental migration of the injected product.

The effects of botulinum toxin last about 3-6 months. After this period, the treatment will need to be repeated to reduce excessive sweating again. We recommend that you contact your physician to discuss your individual situation.

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