Hyperhidrosis is a condition characterized by increased sweating, usually in certain parts of our anatomy (armpits, palms, soles, face …), but may be generalized. Hyperhidrosis can be a medical problem, even favouring infections, but also a social problem, what may cause anxiety and emotional stress to the patient, thus increasing sweating. Most cases of hyperhidrosis are primary, ie, do not have a specific cause, but there are some cases where excessive sweating is related to an underlying disease. Therefore, the dermatologist or the doctor who follows the patient should discard possible pathologies related to hyperhidrosis.

The simplest treatments of hyperhidrosis are different topical antiperspirants on the market, which have limited effectiveness. Among topical antiperspirants, aluminum salts are the most effective, but can irritate the treated area and stain clothes. Another local treatment that can be done at home is iontophoresis, a transcutaneous treatment that involves passing an electrical current through the skin. Iontophoresis may be especially useful on palms and soles, although it has variable effectiveness. For axillary hyperhidrosis, we usually obtain much better results with local injections of botulinum toxin. There are some variations between patients, but the beneficial effects of botulinum toxin on axillary hyperhidrosis start at 3-4 days of the treatment and typically last between 6 and 8 months. Thus, it is only required to repeat the therapy once a year, in Murcia usually in early spring.

Side effects are minimal and patients immediately incorporate to their daily activities. Botulinum toxin results are less spectacular for hyperhidrosis of the palms or soles than for axillary hyperhidrosis, because much more units of botulinum toxin are needed in palms and soles and the duration of the effect is shorter.

Another possible treatment for hyperhidrosis is the reduction or elimination of sweat glands in areas such as the armpit with laser surgery.

In selected and severe cases, sympathectomy by thoracoscopy under general anesthesia is indicated, cauterizing certain sympathetic ganglia responsible for sweating in a particular area, such as the armpits or the palms. Sympathectomy is a technique with definitive and permanent results but often associated with side effects such as compensatory sweating or paradoxical hyperhidrosis, in which, after surgery, you begin to sweat more intensely in areas where previously there was no hyperhidrosis, as the back or the chest.

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