Sweating – Hyperhidrosis

Hyperhidrosis, or excessive sweating, is a common problem that causes many patients great unhappiness and affects their daily lives. Mainly the areas affected include under the arms (called axillary hyperhidrosis), or the palms of the hands and soles of the feet (palmoplantar hyperhidrosis). Underarm hyperhidrosis often starts around puberty, and can continue throughout life if not treated.

Hyperhidrosis facts

  • Hyperhidrosis, or excessive sweating, is a common disorder.
  • Hyperhidrosis usually occurs in people who are otherwise healthy.
  • The approach to treating hyperhidrosis generally proceeds from OTC antiperspirants to prescription antiperspirants, iontophoresis, microwave destruction of sweat glands, oral anticholinergic medications, muscle relaxing injections, and ultimately surgery in the most extreme cases.

Sweating is embarrassing, it stains clothes, and it complicates business and social interactions. Severe cases can have serious practical consequences as well, making it hard for people who suffer from it to hold a pen, grip a steering wheel, or shake hands.

What is the cause of hyperhidrosis?

Although neurologic, metabolic and other systemic diseases can sometimes cause excessive sweating, most occur in people who are otherwise healthy. Heat and strong emotions may trigger hyperhidrosis in some, but many who suffer from hyperhidrosis sweat nearly all of the time. In these people, the sweat glands are overactive and produce significant amounts of sweat.

The approach for treating hyperhidrosis involves

  • Over the counter anti perspirants, such as aluminium chloride which is considered more effective than general antiperspirants.
  • Iontophoresis – this procedure was introduced over 50 years ago as a treatment for excessive sweating.  Its exact mechanism of action is still unclear.  The procedure uses water to conduct an electric current to the skin, which may reduce the production of sweat. Repeated maintenance treatments are advised.

Muscle relaxing injections for sweating.

Muscle relaxing injections may alleviate sweating considerably for many months (up to nine months in some individuals), which can create a profound improvement in quality of life.

  • Iontophoresis: a device which passes direct electricity through the skin using tap water
  • Microwave destruction: a device that aims to destroy the sweat glands while purportedly causing minimal damage to other tissues
  • Oral medications: from the group of medications known as anticholinergics, which can reduce sweating
  • Surgery: cervical sympathectomy, or interruption of certain nerve pathways, as a last resort

Oral medications

Oral anticholinergic medications such as glycopyrrolate are not commonly used for this condition, because at doses that would work, they often produce side effects like dry mouth and blurred vision.

Muscle relaxing injections

Muscle relaxing injections are often used as a cosmetic treatment for wrinkles, but have actually been used in many areas of medicine for some time, such as in the treatment of muscle spasms and certain types of headaches. Their latest medical use is for improving excessive underarm sweating.

The muscle relaxer is injected into the tissues of the armpit or hand. This may produce approximately six months of decreased sweating. The injections are often uncomfortable, but use of a very small injection needle minimises discomfort.

Drawbacks of using this method for the palms and soles are pain, requiring nerve blocks to numb the hands in order to make the injections tolerable, and the potential for temporary muscle weakness.

Dr. Sagoo is experienced at treating armpit and palmar hyperhidrosis with muscle relaxing injections.

The area to be treated is anaesthetised with local anaesthetic cream or injections, and then a series of small amounts of muscle relaxing injections are placed in to the maximum area just under the surface of the skin over the sweat glands.

The treatment takes approximately 30 minutes to carry out with no significant downtime at all.

The areas treated may become dry over the next few days. A review appointment approximately 2 weeks later is arranged to top up, or treat any remaining wet areas. A further treatment is usually recommended in 6-9 months. Results will vary from person to person.


Thoracic sympathectomy refers to surgical interruption of the sympathetic nerves responsible for sweating. Sympathectomy is an operation intended to destroy part of the nerve supply to the sweat glands in the skin. Sympathectomy is both effective and risky complications are serious and not reversible, so this option is rarely used, and then only as a last resort.

For further information about hyperhidroisis and botulinium toxi injections please call us on 0845 603 6150.