Excessive Sweating: Causes and Treatments, Including Botox

When is sweating excessive rather than normal?

Sweating in summer heat or during exercise is normal, especially in a humid climate like the Eastern Province. Sweating is considered excessive when it is heavy enough to soak clothes or drip from the hands, happens in air-conditioning or without effort, has lasted 6 months or more, and affects daily activities such as shaking hands, writing, using your phone or choosing clothes.

Many people notice that the sweating eases or stops during sleep, affects both sides equally and began in childhood or adolescence, and more than one family member may have it.

What causes excessive sweating?

Doctors divide it into two types, each managed differently:

• Primary focal hyperhidrosis: the most common type, caused by overactive nerves that stimulate the sweat glands; it is not a sign of illness and affects specific areas such as the underarms, palms and feet.
• Secondary hyperhidrosis: caused by something else, such as an overactive thyroid, blood sugar problems, menopause, obesity, infection or certain medicines.
• Signs that call for looking for a cause: sweating all over the body, sweating that starts later in life, night sweats that soak the bed, or sweating with weight loss, fever or palpitations.

What treatment options are available?

Treatment usually starts with the simplest option and moves on if that is not enough. Your doctor chooses based on the area affected and how severe the sweating is:

• Strong antiperspirants containing aluminium chloride, applied at night to dry skin; usually the first step for the underarms, palms and feet.
• Wipes or creams containing topical anticholinergics, available on prescription in some cases.
• Iontophoresis: sessions where the hands or feet sit in water carrying a mild electric current; especially useful for palms and soles.
• Botox injections: reduce sweating in the underarms and palms for several months.
• Anticholinergic tablets, prescription-only for widespread sweating, with side effects such as dry mouth.
• Other underarm procedures such as heat-based energy devices; surgery is a rare last resort because of complications, including compensatory sweating elsewhere.

How does Botox work for sweating, and how long does it last?

Botox is botulinum toxin, injected in very small amounts just under the skin of the sweaty area, where it temporarily blocks the nerve signals that stimulate sweat glands. Results usually begin within a few days to two weeks and commonly last 4 to 6 months, sometimes longer, after which the treatment is repeated.

The injections use a fine needle, and they can be uncomfortable, especially on the palms, so a numbing cream or cooling is usually used. Possible effects include minor bruising and, on the palms, temporary weakness of grip. Botox is not recommended during pregnancy or breastfeeding or with certain nerve and muscle conditions, and your doctor decides whether it suits you after an assessment.

Everyday habits that reduce embarrassment

Medical treatment is the foundation, but some habits make sweating easier to live with: wear cotton or moisture-wicking sports fabrics, choose colours that do not show sweat, and carry a spare shirt on important days.

For the feet, use absorbent socks, alternate between two pairs of shoes and dry your feet well to reduce odour and fungal infections. Cut down on hot drinks, caffeine and spicy food if you notice they increase your sweating. If sweating makes you anxious or withdrawn, talk to your doctor; it is a recognised medical condition with solutions.