Excessive Sweating

There are two forms of hyperhidrosis – primary focal hyperhidrosis and secondary generalised hyperhidrosis.

The secondary generalised form usually has a known cause and can be related to an underlying medical condition, e.g., hyperthyroidism, taking certain medications, or due to the menopause. This form of hyperhidrosis involves generalised sweating, all over, such as night sweats or hot flushes.

However, primary focal hyperhidrosis has no known cause, and the word focal comes from focus meaning that sweating is focused in specific areas of the body, typically underarms, hands, feet, face, scalp, and neck, also affecting some people in the groin or on residual limbs in amputees. You may be affected in more than one area of your body, and symptoms often start in childhood or after puberty. Curiously, individuals with primary focal hyperhidrosis do not experience the sweating at night when they are asleep, but often find that sweating causes them much distress and impairs their daily activities and social life.

Estimates suggest that around 1 to 3 people in every 100 people in the UK are living with hyperhidrosis. Globally, it is about 5% of the world’s population, making it a common condition.

At Blemish Clinic, we can discuss the treatment options available to address primary focal hyperhidrosis and find the right solution for you.

Depending on where you experience the problem with excessive sweating, there are several things that people often try as lifestyle choices to cope with the increased sweat (and extra body odour that may result), but these are not effective treatments, just coping strategies. These may include frequent bathing, frequent changes of clothes and socks, regular application of deodorant or antiperspirant, choosing shoes, socks and clothing made from natural fibres, avoiding alcohol and trigger foods, like spicy dishes, or using relaxation techniques if sweating can be triggered by anxiety.

In the first instance, we must diagnose primary focal hyperhidrosis (you may already have a diagnosis from your GP) and then we can review the treatment options available, depending on the area affected. Some people find some relief with non-prescription items available at pharmacies, such as stronger antiperspirants containing aluminium chloride, foot powders, soap substitutes or astringents, or clothes protectors and sweat shields.

Other treatment options, which tend to be offered via a referral from your GP practice include prescription strength antiperspirants containing aluminium chloride hexahydrate; special tablets called anticholinergics or antihidrotics to reduce sweating by blocking chemical signals, but which can have side effects including dry mouth, constipation, and difficulty urinating; or iontophoresis which is used especially for palmar and plantar hyperhidrosis by passing a weak electrical current through water or a wet pad over your hands and feet. A more invasive option for axillary or underarm hyperhidrosis is surgery where the sweat glands are removed in an operation called a sympathectomy, or microwave energy used to destroy sweat glands.

At Blemish Clinic, we can also discuss an alternative treatment option with you during a consultation with our medical practitioner which uses the prescription medicine botulinum toxin to temporarily reduce sweating in the area affected. In the UK, Botox® (botulinum toxin type A) is a licensed medicine for the ‘management of severe hyperhidrosis of the axillae, which does not respond to topical treatment with antiperspirants or antihidrotics’.

Botulinum toxin is a prescription only medicine that is one of the options available for treating primary focal hyperhidrosis. It is available under the brand name Botox® and can be prescribed for you after a medical consultation, to include taking a medical history, and a full discussion about your history of excessive sweating and the treatment options you have considered or may wish to consider.

Botox is injected into the area affected, usually with multiple injections in a grid-like pattern and works by blocking the chemical signals being sent from the nerves to the sweat glands, this effectively turns off the sweat glands and they stop or significantly reduce their sweat output, bringing relief to the hyperhidrosis sufferer. The effect is temporary, wearing off after several months, so does require repeat treatment; however, for many the relief is worth it, and they often find they can stop using deodorants completely whilst undergoing treatment.

Your suitability for a variety of treatment options for primary hyperhidrosis, including botulinum toxin or Botox injections will be discussed during a consultation with our medical practitioner. If after taking a full medical history, discussing any underlying medical conditions, medications, and allergies, understanding your experience with excessive sweating, and a physical examination, they believe you would be a suitable candidate for treatment, you can be prescribed the medication and have it administered to reduce your sweating.

If your excessive sweating is due to an underlying medical condition or your medication, we will refer you back to your GP for a review.

If you suffer from a neurological condition that causes muscle weakness – myasthenia gravis – you will not be suitable for treatment with botulinum toxin.

If you are pregnant or breast feeding, you will not be suitable for hyperhidrosis treatment using botulinum toxin, however we can discuss other options for use during this time to relieve your symptoms.

Depending on the depth, size, and sensitivity of the area being treated, the injections may be barely felt, tolerable, or uncomfortable, for this reason we offer the application of a numbing cream (topical anaesthetic) or cooling to the area prior to treatment, and in some cases can use a local anaesthetic injection to numb the area beforehand.

The use of Botox (botulinum toxin) to treat axillary or underarm hyperhidrosis is now well researched with multiple published, independent clinical studies reporting that treatment is safe with minimal side effects.

There will be little to no discomfort or downtime following treatment, other than some slight redness, swelling, or bruising at the injection points that will fade within 24-48 hours.

There is a risk that you will experience something called compensatory sweating, whereby other areas of the body may sweat more after the injections have stopped underarm sweating, around 4-5 people in every 100 treated experience this after treatment, but it usually resolves within 4 months.

Rarely you may experience a headache, feel sick, or experience muscle pain or weakness after treatment. All potential and rare side effects will be fully discussed during your consultation.

Treatment with Botox for primary hyperhidrosis does not cause an immediate result as the botulinum toxin will take up to 2 weeks to take effect, reducing the nerve impulses and consequently reducing the sweating after a week or two.

According to the International Hyperhidrosis Society, underarm Botox injections can reduce underarm sweating by 82–87%.

The length of time of the effect of reduced or no sweating in the area treated will depend on many factors – your sweating severity and triggers, the specific area affected, your sex etc.

There is good clinical data now available to assert that typically underarm sweating can be reduced by more than 80% and will last between 4 and 12 months, some people can experience effects for as long as 14-16 months, but the average claimed by the medicine manufacturer is 4-7 months before you will need a repeat treatment. Once the effect starts to diminish and the sweating returns, you will be able to schedule a repeat treatment, this cannot be more frequently than every 16 weeks (4 months).

The treatment may not last as long in other areas, but relief can be significant. Over time the gaps between repeat treatments may also lengthen.

We believe in being transparent with our prices and want you to be fully aware and comfortable with the cost of your treatment. A full list of our prices can be found here. We will always agree a final price with you though before treatment commences.