Sweating is a normal physiologic response to increased body temperature and is an important mechanism in releasing heat produced from endogenous as well as exogenous sources. Hyperhidrosis simply describes excess sweating beyond that necessary for physiological thermoregulation and homeostasis. It can lead to embarrassing social and occupational situations as well as have a psychologic impact on the patients affected. In addition, profuse sweating can often result in skin maceration, which can lead to secondary bacterial infections of the area. Although hyperhidrosis is generally not considered a cosmetic problem, many patients will present to the cosmetic dermatologist for treatment of this disorder. Hyperhidrosis is the result of sympathetic hyperactivity of the eccrine sweat glands. It can be primary or secondary and of focal or generalized distribution. The most common type is primary focal hyperhidrosis. Primary hyperhidrosis means the cause is not related to another condition such as obesity, menopause, drug use, endocrine disorders (hypoglycemia, hyperthyroidism) or neurological conditions involving autonomic dysregulation. It tends to occur in areas with a greater concentration of eccrine glands, such as the axilla, palms, soles, and groin. It is often manifested in the second or third decades of life and has a family history in 30–50% of cases.
The amount of sweat necessary to be considered “excessive” is not well-defined and is variable between individuals. Patients with hyperhidrosis do not demonstrate any histopathologic changes in their sweat glands, nor are there any changes in the numbers of sweat glands. Hyperhidrosis may be generalized or focal, bilateral or unilateral, symmetric or asymmetric, primary or secondary in origin. Generalized hyperhidrosis affects the entire body whereas focal hyperhidrosis occurs in discrete sections of the body. Generalized hyperhidrosis is usually secondary in nature, and the differential diagnosis is extensive. Focal or localized hyperhidrosis may result from a secondary process including lesions or tumors of the central or peripheral nervous system. Recently the FDA (Food and Drug Administration) approved the use of Botox as a treatment for hyperhidrosis because Botox prevents the release of acetylcholine. If acetylcholine is not released the sweat gland will not be stimulated to produce sweat. This treatment has been proven to effectively decrease the production of sweat by 95% within the first forty-eight hours and will reach a peak within two weeks. There may be simultaneous disappearance of odor associated with decreased sweating, but this is not consistent. The effects last an average of six to nine months and some patients require only one treatment. During the hyperhidrosis treatment, the area to be treated is identified and then injected with Botox through a small needle. If needed, a topical anesthetic can be used, but usually there is minimal discomfort involved. There has been no evidence of compensatory sweating in other areas following the use of botox. If the sweating returns after treatment with Botox, patients report that the sweating decreased in severity. Botox injections offer a safe, approved and cost effective solution and produces excellent results.. The use of Botox in these patients greatly improves their quality of life and confidence both socially and in their careers.