Indications

Hyperhidrosis is a distressing condition and sufferers have usually tried a variety of modalities including antiperspirants, deodorants, iontophoresis, antimuscarinic topical agents (e.g. Glycopyrrolate cream), oral medication such as oxybutynin or beta-blockers.

Those with severe hyperhidrosis may resort to surgical procedures such as endoscopic thoracic sympathectomy (ETS) to alleviate symptoms.

Affected people are constantly aware of their condition and try to modify their lifestyle to accommodate this problem. This can be disabling in professional, academic and social life, causing embarrassments. Many routine tasks become impossible chores, which can have devastating emotional effects on one’s individual life.

Excessive sweating of the hands interferes with many routine activities, such as securely grasping objects. Some hyperhidrosis sufferers avoid situations where they will come into physical contact with others, such as greeting a person with a handshake.

I have come across people who have given up their studies as they could not write on a piece of paper without soaking it with sweat or musicians who had to change career as using their musical instruments became ‘mission impossible’.

Hiding embarrassing sweat spots under the armpits limits the sufferers' arm movements and pose. In severe cases, shirts must be changed several times during the day.

Excessive sweating of the feet makes it harder for patients to wear slide-on or open-toe shoes, as the feet slide around in the shoe because of sweat.

Hyperhidrosis can also affect the face, neck and scalp and it tends to affect men more than women occurring later on in life. The area most commonly affected in facial hyperhidrosis is the upper band of the forehead where studies suggest that the density of sweat glands is greater, followed by upper lip and cheek. The scalp may also be affected. These areas can also be effectively treated with botulinum toxin injections.

Botulinum toxin is a safe and effective treatment of excessive sweating for all people who think that their perspiration interferes with their quality of life.

Contra-indications

Patients suffering with myasthenia or amyotrophic lateral sclerosis, as well as patients taking certain antibiotics (e.g. aminoglycosides), and pregnant or breastfeeding women should not undertake treatments involving botulinum toxin injections.