Body Hyperhidrosis of hands, feet and axillae
Hyperhidrosis of the hands, feet, and axillae is a common but often underestimated condition characterized by excessive sweating, regardless of temperature or physical activity. It can significantly affect daily life, professional activities, and self-confidence.
Today, there are safe and effective medical solutions, with botulinum toxin treatment being the most widely used. This treatment can markedly reduce sweating for several months. Management is individualized, minimally invasive, and performed in the clinic, allowing immediate return to daily activities. Proper diagnosis and appropriate treatment can substantially improve quality of life.
In the human body, sweat is produced by two different types of sweat glands:
Eccrine glands (the main source of sweat for thermoregulation):
They produce a thin, watery, almost odorless sweat. They are distributed throughout the body but are more concentrated on the forehead, palms, and soles. They are active from birth.
Apocrine glands (axillae, groin):
They secrete a thicker fluid rich in lipids and proteins. When these substances are broken down by skin bacteria, they are responsible for unpleasant body odor. Apocrine glands drain into hair follicles and become active after puberty.
Sweat is not a detoxification mechanism. This role is performed by the liver and the kidneys. Therefore, the local reduction of sweating (e.g. in the axillae) does not lead to retention of “toxins” and does not burden the body.
Photo gallery / before & after
Photo gallery / before & after
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What is sweat composed of?
Sweat is composed primarily of water, but it also contains small amounts of dissolved substances. Its composition varies slightly depending on the type of sweat glands.
Water (≈99%): The main medium for regulating body temperature.
Electrolytes: Sodium (Na⁺), chloride (Cl⁻), potassium (K⁺), calcium (Ca²⁺), and magnesium (Mg²⁺) in trace amounts.
Metabolic by-products: Urea, uric acid, and ammonia (in very small quantities).
Lactic acid
Trace elements: Zinc and copper (in minimal amounts).
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Can the fact that sweat is not released be associated with other unpleasant conditions, such as body odor?
No. Reducing or inhibiting sweating with botulinum toxin is not associated with an increase in body odor; on the contrary, it usually leads to a noticeable improvement. This is because:
Sweat itself is odorless.
Body odor develops when skin bacteria break down the components of sweat, particularly in the axillary area.Less sweat = less substrate for bacteria.
By significantly reducing the amount of sweat, botulinum toxin also limits the bacterial activity responsible for unpleasant odor.No toxins or substances are “trapped.”
Sweat glands do not function as detoxification organs; therefore, the local inhibition of sweating does not result in the accumulation of harmful substances.The body’s thermoregulation is not disrupted.
Normal sweating continues from other areas of the body.In conclusion, treatment of axillary hyperhidrosis with botulinum toxin does not cause body odor; instead, it very often reduces it significantly and improves daily comfort and self-confidence.
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How is botulinum toxin blocking the sweat glands?
Botulinum toxin acts on sweat glands by inhibiting the transmission of the nerve signals responsible for sweating.
Specifically, eccrine sweat glands are stimulated by sympathetic nerve endings that release acetylcholine. Botulinum toxin blocks the release of acetylcholine at the neuroglandular junction, preventing the nerve signal from reaching the gland. As a result, the gland remains functionally “silent,” and sweat production is markedly reduced.
This effect is local and reversible. It does not destroy the sweat glands nor does it affect the body’s overall thermoregulation. The result typically appears within 3–7 days and lasts on average 6–9 months. This is a safe, targeted, and scientifically well-documented mechanism, explaining why treatment of palmar, plantar, and axillary hyperhidrosis with botulinum toxin has high success rates and leads to a substantial improvement in quality of life.
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Can the repeated treatment with botulinum toxin induce the reduction of sweat production?
Repeated treatment with botulinum toxin can indeed, in many patients, lead to a gradual long-term reduction in sweat production, without destroying or reducing the number of sweat glands. What actually occurs is the following:
The toxin does not destroy the glands nor cause their atrophy.
Its action is neurological rather than structural: it repeatedly blocks the neural stimulation of the sweat glands.
Over time, in some individuals, this may result in:
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reduced severity of hyperhidrosis
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longer duration of effect between treatment sessions, up to 12 months
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a decreased need for frequent repeat treatments
Chronic inhibition of cholinergic stimulation appears to lead to a form of functional “re-education” of the neural control of sweating. This is not a permanent deactivation, but rather a reduction of system overactivity, without affecting normal sweating in other areas or causing compensatory hyperhidrosis.
Conclusion: Repeated treatment with botulinum toxin does not “eliminate” the sweat glands, but it may reduce their functional hyperactivity over time, offering more stable and predictable long-term control of hyperhidrosis.
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Are there any significant differences between axillary hyperhidrosis and palmar-plantar hyperhidrosis?
Axillary hyperhidrosis and palmar–plantar hyperhidrosis share a common underlying mechanism, but they differ significantly in clinical presentation, symptoms, and therapeutic approach. Specifically, in the palms and soles, only eccrine sweat glands are overactive. Apocrine glands are absent, and therefore body odor is not observed.
However, palmar and plantar hyperhidrosis may be associated with social discomfort due to:
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difficulty with handshaking
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problems with writing and the use of tools or touch screens
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difficulty with walking
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an increased risk of dermatitis or fungal infections of the feet
In both forms, treatment with botulinum toxin is highly effective.
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