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Hyperhidrosis. Treatment of profuse sweating with botulinum toxin (Botox).

Hyperhidrosis is any condition in which there is profuse sweating in excess of that required to maintain normal regulation and homeostasis. There are two main types - generalized and localized. In the first case, profuse sweating affects the entire surface of the body, and in the second case, it is concentrated in certain areas. In localized hyperhidrosis, the most commonly affected areas are the armpits, palms and soles. It is necessary to rule out an underlying disease or a side effect from medications taken as the cause of this condition. Profuse sweating can manifest itself in different degrees and significantly impair the quality of life.

Hyperhidrosis - causes

There are many causes of profuse sweating. Most of them are completely natural and are a mechanism for our body's adaptation to different conditions. The most common causes of excessive sweating are high temperature (body and environmental) and physical exertion. They represent a protective reaction, protecting the body from overheating. The sweat droplets separated on the skin surface evaporate, which lowers the temperature and cools the body. Sweat secretion also increases in a state of stress.

Other causes of hyperhidrosis can be various infectious conditions, taking certain medications, underlying diseases. In these cases, most often the process is generalized and the sweating is expressed on the skin of the whole body.

Many people complain of unexplained sweating localized in the armpits, palms and soles. It becomes more abundant during stress and psycho-emotional tension. In these cases, no underlying disease or cause is found and it is referred to as localized hyperhidrosis.


Treatment of profuse sweating

Hygienic and dietary regime – Includes wearing seasonally appropriate clothes made of natural and non-steaming materials, maintaining a normal body weight, avoiding spicy foods, and drinking enough fluids.

Antiperspirants – They represent a group of medications that aim to reduce the efficiency of the sweat glands. They are most often the first choice for treating hyperhidrosis. The active ingredient is aluminum salts in different concentrations, which lead to swelling of the sweat glands and a decrease in the amount of sweat released. A common adverse reaction is local redness and irritation of the skin.

Anticholinergics – Another group of medications, but with a systemic effect. They are highly effective, but they also have a number of side effects such as dry mouth, keratitis, constipation, palpitations, chest pain. Nowadays they are not used because of the high risks and side effects of the therapy.

Iontophoresis – For the treatment of profuse sweating of hands and feet. The palms and feet are immersed in a container of water for about half an hour, through which a weak electric current passes. Several procedures are carried out for an initial effect, then maintenance therapies 1-2 times a week. The low efficiency and the need to regularly repeat the procedures are the reason why iontophoresis is not used nowadays.

Sympathectomy – Surgical treatment in which the sympathetic nerves that stimulate the release of sweat from the glands are surgically removed. As an operative intervention, it carries a number of risks and is avoided.

Botox – Botulinum toxin injection is probably the best anti-sweat remedy. Its advantage over other alternatives is its easy implementation, reliable effect, lack of side reactions and recovery period. The procedure is carried out once, within one session, and the effect is already present in the first days afterwards. It is suitable for all persons over 18 years of age, and for minors it is used for strictly fixed medical indications. The effect of botulinum toxin lasts between 4 and 12 months.

When is Botox needed to treat hyperhidrosis?

  • with profuse sweating of the palms or soles
  • with excessive sweating in the armpits
  • in case of ineffectiveness of some of the conventional methods of treatment of profuse sweating
Хиперхидроза - колко време отнема процедурата
възстановяване след ботокс за хиперхидроза
лечение на обилно потене - трайност
лечение на хиперхидроза - цена

Profuse perspiration under the arms

Botulinum toxin is most often used to treat profuse underarm sweating. The procedure usually begins with the so-called iodine test, in which an iodine solution is applied to the treated area. It helps us to find exactly the areas with the most expressive sweat secretion. An anesthetic is applied in the form of a cream, which needs to stay for about 30 minutes. The lidocaine is then removed and the area cleaned. Botox is injected in small doses through several millimeters. The level of injection is essential - in these cases we are not targeting the muscles, but the deep part of the dermis. The skin is then cleansed. The effect starts after a few days, with a drastic reduction in sweating. Its duration is 6-10 months.

Profuse perspiration under the arms
Profuse perspiration under the arms

Hyperhidrosis of the palms

Excessive sweating of the palms is a common form of localized hyperhidrosis that significantly impairs the quality of life. It makes it impossible to work with documents and electrical appliances. Unfortunately, conventional methods of therapy are not effective, making botulinum toxin the only option. The procedure proceeds in a similar way. The skin is again first cleaned and anesthetized with lidocaine cream, then punctures are made with a fine needle and botox is injected at the level of the dermis. The effect is visible after a few days, and the duration of the effect is up to 1 year. It should be noted that it is normal in the first few days after the procedure to feel muscle weakness in the area of ​​the palms, which is expressed in the impossibility of strongly squeezing objects. This effect is transient and goes away in a few days. Excessive sweating of the feet is treated similarly.

Hyperhidrosis of the palms
Hyperhidrosis of the palms

Post-treatment care

On the day after the procedure, do not exercise or drink alcohol. Do not clean treated areas with disinfectants and products that may contain alcohol or alcohol. Avoid saunas, steam baths and other heat treatments for the next few days. The effect will begin to manifest itself in 3-4 days. When injecting in the palms of your hands, you may experience weakness when you try to squeeze, but this feeling goes away in a few days.

Price for treatment of hyperhidrosis with Botox in Sofia

Our prices vary from 650 to 800 BGN depending on the number of units used. For current prices of the offered services you can see ours pricelist.

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Treatment of profuse sweating in Sofia

Do you suffer from profuse sweating of your armpits, palms or feet? Come to a free aesthetic consultation at Dr. clinic. Stavrov Aesthetics, within which we can get to know each other and discuss your wishes. We are located in the city of Sofia, Manastirski livadi - zapad, Prof. Velizar Velkov St. 36. You can find more information in the section contact page.


Pregnancy, lactation, local infection in the treated area, malignant and some autoimmune diseases.


What causes profuse sweating?

Profuse sweating can be due to many reasons - physical exertion, stress, infection, side reaction from taking certain medications, underlying disease.

What is the most effective antiperspirant?

The best medicine against localized sweating in the armpits, palms and soles is botulinum toxin.

At what age can Botox be used to treat hyperhidrosis?

Botulinum toxin is approved for the treatment of profuse sweating in people over 18 years of age. With certain medical indications and permission from a parent, it can also be used in persons over 16 years of age.

Botox for the treatment of hyperhidrosis - reviews

I work in an office and I'm always in a shirt and jacket, but the excessive sweating under my arms causes me to often ruin my clothes. Deodorants did not give the desired result. I tried botox and in my opinion it is the best antiperspirant.

Georgi, 37, Sofia

I have suffered from sweaty hands since I was little. It was impossible to work with documents and a computer before I tried botox treatment. Now I wear it once a year and I am very satisfied.

Milena, 27, Sofia

Review of Dr. Stavrov, aesthetic dermatologist in Sofia

Botulinum toxin is the most effective method of dealing with unwanted sweating. It provides safe and lasting results. As episodes of hyperhidrosis become most pronounced in the summer, our patients most often visit us in the spring months for this case.

Dr. Konstantin Stavrov, co-owner of Dr. Stavrov Aesthetics clinic in Sofia

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