Excessive Sweating

Excessive sweating is common and can be a source of real distress and have a big impact on your quality of life. Help is available.

We can offer both Botox injections for armpit (axillary) sweating and iontophoresis for hand and foot sweating.

Please read on for more information.

Types of Hyperhidrosis (excessive sweating)

There are two types of hyperhidrosis:

  1. Primacy Focal
  2. Secondary generalised

Understanding the difference is one of the first steps in understanding hyperhidrosis.

Primary focal hyperhidrosis refers to excessive sweating that is not caused by another medical condition, nor is it a side effect of medications.

This type of sweating occurs on very specific areas of the body (described as focal areas) and is usually relatively “symmetric” meaning that both the left and right sides of the body are affected similarly. The most common focal areas are the hands, feet, underarms, and head or face.

Primary focal hyperhidrosis often begins in childhood or adolescence, especially hyperhidrosis of the hands and feet. Interestingly, although people with primary focal hyperhidrosis have episodes of excessive sweating at least once a week, they usually do not experience excessive sweating while sleeping. It’s also been shown that primary focal hyperhidrosis may be inherited and many members of the same family may suffer from this condition (but sadly many never talk about it with each other because of embarrassment). Around 90% of people with excessive sweating have this type.

The other main type of hyperhidrosis is referred to as secondary generalized hyperhidrosis. This type of excessive sweating is caused by another medical condition or is a side effect of a medication. It can involve larger areas of the body and may occur while sleeping. We will determine if this is a concern at your initial consultation and perform any necessary tests.

Botox for sweating

Botox, also known as Onabotulinumtoxin A,was first approved for the use of excessive sweating of the underarms in 2004 in the USA.

BOTOX is produced by Allergan, and it is the most studied brand of botulinum toxin in the world. BOTOX has been available for well over a decade and has been used to treat millions of patients with various conditions, including spasticity and movement disorders.

OnabotulinumtoxinA is a natural, purified protein which temporarily blocks the secretion of the chemical that is responsible for “turning on” the body’s sweat glands. By blocking this chemical messenger, botulinum toxin “turns off” sweating at the area where it has been injected.

The use of Botox for this problem is very safe and effective. In most people sweating is at least reduced by half. Results can last for around 7-12 months.

While sweating is an essential body function for temperature-control, the underarms contain less than 2% of the body’s sweat glands. Blocking these sweat glands has no effect on the bodies overall temperature control and there is no increase in sweating in other areas ( unlike the compensatory sweating that can occur after surgery).

Injections can be administered in our rooms, require about 20 minutes to perform, and do not demand any restrictions in work or leisure activity (aside from refraining from intensive exercise or the use of a sauna on the day of the injections).

During the procedure, a very fine needle is used to inject tiny amounts of Botox just under the skin near in the area of excessive sweating every 1 to 2 centimeters. Treatment of the underarms is usually not painful and easy to withstand. If you are anxious local anaesthetic cream can be applied for an hour prior to the procedure.

There is a possibility that during the procedures some sweat glands may be missed. As a result, you may continue to experience some sweating from the areas missed. If this happens, it’s important to tell us so we can reevaluate the sweating areas and perhaps “fill in” the gaps with additional injections. This usually takes care of any sweating in the treated areas.

Botulinum toxin injections do not cure hyperhidrosis; your symptoms will go away gradually (usually in about a week) and return gradually. Follow-up injections are required to maintain dryness. These repeat injections may be necessary at intervals varying from seven to sixteen months.


Treatment of excessive sweating of the hands and feet with iontophoresis has been practiced since the 1940s. It is particularly useful for people who’ve tried prescription or clinical strength antiperspirants but find that they need a stronger treatment. For people with hyperhidrosis of the hands and/or feet, iontophoresis treatments typically result in significantly decreased sweating with a very high success rate—over 80%.

Iontophoresis uses water to conduct a mild electrical current through the skin’s surface. While it’s not entirely understood how or why iontophoresis works, it is thought that the electric current and mineral particles in the water act together to microscopically thicken the outer layer of the skin, thereby blocking the flow of sweat to the skin’s surface. Once this sweat output is blocked or interrupted, sweat production in the treated areas is reduced.

Iontophoresis has no significant or serious side effects and the drying results do not decrease in effectiveness with long-term use.

Patients sit with both hands or both feet, or one hand and one foot, immersed in shallow trays filled with tap water, and a special chemical called glycopyronium bromide, for a short period of time (20 to 40 minutes) while the device sends a mild electrical current through the water. The process is normally repeated weekly for about 4 weeks.

Once the desired dryness has been achieved, patients are switched to a maintenance schedule, usually weekly to monthly depending on the individual. To maintain dryness, iontophoresis treatments should be conducted before sweating begins to return, or the process may need to be started all over again to obtain the desired dryness.

Successful iontophoresis treatment does require a commitment to ongoing treatment. One of the limitations can be the time commitment especially in the early stages of treatment. We understand this and aim to have your visits run as efficiently as possible .

Iontophoresis is not usually recommended for excessive underarm sweating (axillary hyperhidrosis) because the skin in the armpits is likely to be irritated by the process and because it is very difficult to perform iontophoresis on the underarms. Botox injections are the best option for this area.