Primary and secondary hyperhidrosis
Hyperhidrosis is defined as sweating far beyond the need for thermoregulation. It is divided into two main types: primary (idiopathic, unknown cause) and secondary (due to another disease). Primary hyperhidrosis usually starts at a young age, is symmetrical and regional (armpits, hands, feet, face), and a family history is common. Secondary hyperhidrosis is accompanied by generalized sweating, night sweats, and other symptoms; causes such as thyroid, diabetes, infection, and drug side effects are investigated.
Botox is effective for primary hyperhidrosis. In secondary hyperhidrosis, the underlying disease is treated first; then botox is evaluated for the remaining symptoms.
Mechanism of action
Sweat glands, like mimic muscles, work with acetylcholine signals. Since botox blocks acetylcholine release at the nerve ending, it stops the stimulation of the sweat gland. The signal reaching the gland, not the muscle, is silenced. The sweat gland does not disappear, it just doesn't receive signals; therefore, the effect is reversible and lasts about 6-9 months.
The most common statement from my patients after hyperhidrosis treatment is "I started wearing my t-shirts without throwing them away." Behavioral changes in social life are very noticeable — daily restrictions such as the obligation to wear dark colors, avoiding handshakes, and hesitating to raise arms disappear.
Daily life (before treatment)
- Obligation to wear dark and thick fabrics
- Changing clothes during the day
- Avoiding handshakes
- Having to go to the restroom before meetings
- Anxiety about bad odor and heavy deodorant use
Daily life (after treatment)
- Comfort of light and thin fabrics
- Single outfit all day long
- Normalizing handshakes
- Ease of sweat control after sports
- Natural odor balance
Application technique
Armpit: 50 units on each side (total 100 units) are applied spread over approximately 20-30 points. The sweating area is first mapped with iodine-starch (Minor test). The needle is superficial, placed at the dermis-subcutaneous border. Palm application is more painful; it is applied with local anesthetic blocks or topical anesthesia. The sole of the foot is similar.
Forehead application requires more care: spread to the frontalis muscle can cause eyebrow drooping. Therefore, injections are very superficial and in small doses (total 15-25 units).
Duration of effect and repetition
The effect starts in 3-7 days and is fully established after 2 weeks. The result lasts 6-9 months; in some patients, it can extend up to 12 months. 1-2 repetitions per year are sufficient. The regeneration rate of sweat glands does not change with repeated treatments — so there is no "it will be needed less now" situation; however, the patient learns their calendar well and plans ahead (before summer, before important events).
Hyperhidrosis treatment is sometimes partially covered by private health insurance in Turkey. For patients with severe effects, an application with a doctor's report and medical justification is logical.
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