Treatment for excessive sweating (hyperhidrosis)

Hyperhidrosis means sweating more than the body needs to regulate its temperature. It often affects the underarms, palms or soles and can interfere with daily life: clothes become stained, shaking hands becomes awkward and shoes wear out faster.

One of the treatments used is the injection of botulinum toxin into the skin of the affected areas. The substance temporarily blocks the nerve signal that stimulates the sweat glands, so that they produce less sweat. At Detalii Med in Baia Mare, the treatment is carried out by Dr Greta Jurj, Dr Alina Perța, Dr Marius Pruna and Dr Valeria Pruna.

The treatment is usually suitable for people who:

• sweat excessively from the underarms, palms or soles, without an identified medical cause;
• have not achieved a sufficient result with ordinary antiperspirants;
• experience real discomfort in their social or working life because of sweating.

The procedure is not recommended during pregnancy or breastfeeding, where there is an infection in the area to be treated, or for people with certain neuromuscular conditions. At the consultation the doctor also reviews current medication, as some medicines can affect how the toxin works.

Botulinum toxin can significantly reduce sweating in the treated area for a limited period. Many patients notice they no longer have marks on their clothes or that they can use their hands more comfortably at work and with other people.

The treatment does not cure hyperhidrosis and its effect is not permanent: the glands gradually resume their activity and the injections need to be repeated. It does not act on untreated areas and does not resolve sweating caused by another condition. Nor does it completely eliminate odour, although this often lessens as sweating decreases. The strength of the effect varies from person to person.

At the consultation, the doctor asks when the sweating started, which areas are affected, whether it also occurs at night, what makes it worse and which treatments have been tried. The aim is to distinguish primary hyperhidrosis, which has no specific cause, from secondary sweating, which may be linked to hormonal disorders, infections, certain medicines or other health problems.

If there are signs of a secondary cause, the doctor recommends investigating it first. Medical history, allergies and the patient's expectations are discussed. A simple test is sometimes used to show on the skin the area that sweats most, in order to guide the injections.

The session usually lasts between 20 and 45 minutes, depending on the areas treated. The skin is cleaned and disinfected, and the doctor marks the area to be injected, sometimes as a grid of points.

The toxin is injected superficially into the skin in small, evenly distributed amounts. In the underarms the procedure is usually well tolerated. On the palms and soles, where the skin is more sensitive, the doctor takes extra steps to reduce discomfort. The patient can go home straight after the session.

In most cases no anaesthesia as such is needed. For the palms and soles, the doctor may use an anaesthetic cream, cooling of the area or, depending on the case, other local anaesthesia methods. The method is agreed at the consultation.

There is no real recovery period, and usual activities can be resumed the same day. The injection points may remain slightly red or swollen for a few hours.

Usual recommendations:

• avoid massaging the area on the day of treatment;
• avoid strenuous exercise, saunas and hot baths for the first 24 hours;
• use antiperspirant on the underarms only once the doctor allows it, usually the next day.

The doctor may schedule a follow-up after a few weeks to check the effect.

The treatment is generally well tolerated but may have unwanted effects:

• pain, redness or small bruises at the injection site;
• slight temporary weakness of the small muscles of the hand after treatment of the palms;
• compensatory sweating in other areas, sometimes reported;
• rarely, allergic reactions or local infection;
• a weaker effect than expected in some patients.

Unwanted effects are usually temporary. Any unusual symptom after the procedure should be reported to the doctor.

The effect usually starts to show after a few days and is fully established in about two weeks. Sweating decreases in the treated area, although it does not always stop completely.

How long the effect lasts varies from person to person. In the underarms it often lasts between 4 and 9 months, while on the palms and soles it may be shorter. When sweating returns, the treatment can be repeated at an interval agreed with the doctor.

Botulinum toxin is a useful option for excessive sweating of the underarms, palms or soles, with a temporary effect lasting several months. Before treatment, the medical consultation aims to rule out secondary causes of sweating. At Detalii Med, the doctor decides which areas to treat and how often to repeat the treatment according to each patient's response.