Hyperhidrosis, (the medical term for excessive sweating) is a medical condition that is defined as sweating beyond what is necessary to maintain thermal regulation. Sweating is a necessary normal biological function of our body that helps regulate and maintain body’s temperature (keeps our bodies cool). Excessive Sweating (known as hyperhidrosis) causes emotional stress, social isolation and affects the person’s school, work, friendships, romance and sporting activities. Hyperhidrosis involves more sweating than what is required by our body. It causes extreme dripping of sweat in armpits, hands, feet, face and visible underarm sweat rings minutes after putting on clothes. Victims typically avoid wearing particular fabrics and colors because the sweat can leave rings and stains and are more visible on them. What’s more they would perhaps constantly worry about the problem of body odor which no amount of deodorant could hide. This sweat is almost totally resistant to all the types of deodorants and other odor controlling medications.

Sweat is produced by the sweat glands. There are two types of glands in our body.
The eccrine glands are found all over the body but particularly concentrated on the palms of hands, soles of feet, underarms, and forehead. They produce an odorless watery solution in unlimited quantities. Their primary function is the secretion of sweat that regulates body temperature. These glands also excrete the ingested material of onions and garlic. The glands are under control by sympathetic cholinergic nerves which are in turn controlled by the hypothalamus (the region of our brain that regulates metabolic processes and other autonomic activities). So it is the hypothalamus that senses a change in temperature both directly as well as from messages it receives from temperature receptors in the skin. Once it realizes the need for temperature regulation it modifies the sweat output. This is the body's natural method of cooling itself down during active periods (such as exercise) or exposure to warm conditions. A person with hyperhidrosis experiences uncontrolled sweating and/or blushing.

The apocrine glands, which are larger than eccrine glands, are scent (odor) glands and found in limited areas. They are located in the underarms and the genital skin, where they secrete their sweat into the hair follicle. Unlike eccrine glands, the sweat from apocrine sweat glands contains fatty materials. It attracts bacteria that break down these organic compounds and release the unique odor of each person. Thus apocrine glands basically serve as scent glands. Their function is regulated by hormonal processes. Excessive sweat from apocrine glands produce malodor of the axillae and genitals (called osmidrosis).

Hyperhidrosis can be classified as primary or secondary, depending on its cause or origin. Primary hyperhidrosis, also known as essential or idiopathic hyperhidrosis, is caused by an overactive sympathetic nervous system. Primary hyperhidrosis can lead to intractable and profuse sweating in several locations typically affecting the feet (plantar), armpits (axillae), and hands (palmar). Hyperhidrosis can be accompanied by facial blushing. Secondary hyperhidrosis usually affects the whole body and can be associated with miscellaneous underlying causes such as malignancy, infection, spinal cord injury, neurologic and endocrine disorders.

Hyperhidrosis may begin in infancy or childhood but it usually appears in adolescence and lasts throughout adulthood, affecting 0.6%–1% of the general population. It appears to run in families and is more common in certain ethnic groups. Hyperhidrosis may result in persistent eczematous dermatitis, skin maceration with bacterial or fungal infection, and acute inflammatory pruritic eruption due to blockage of sweat gland ducts and retained sweat in the affected areas. Hyperhidrosis can disrupt an individual’s social and professional life and may lead to emotional distress.

Treatment options

Non Surgical Treatments:
These are temporary and less effective

	Topical Treatments: Over-the-counter antiperspirants and deoderants containing aluminum salts are used to treat hyperhidrosis. The most effective topical treatment for palmo-plantar hyperhidrosis is 20% aluminum chloride hexahydrate (e.g., Drysol). Aluminum salts can cause skin irritation and itching, leading to skin infections. Other topical agents have less satisfactory results (e.g., boric acid, anticholinergics drugs, resorcinol, tannic acid, potassium permanganate, formaldehyde, methenamine, and glutaraldehyde).
	Systemic Treatments: Systemic anticholinergics, beta blockers and benzodiazepines. These treatments can have numerous side effects, such as nausea, dizziness, blurred vision, dry mouth, lethargy and drowsiness.
	Iontophoresis: Iontophoresis is primarily used for focal hands and feet hyperhidrosis, since the hands and feet are the easiest body parts to submerge in water. The treatment involves the use of a low-intensity electrical current to enhance drug penetration through the skin by introducing various ions. The limitation of this treatment is it causes skin irritation, peeling, and drying. This treatment is time consuming, in that it may require 30–40 minute treatments daily for at least four days a week. Technology Evaluation Center (TEC) Assessment on iontophoresis concluded that the evidence was insufficient to determine whether the effects of iontophoresis for the treatment of hyperhidrosis exceed those of placebo. There is insufficient evidence to support the efficacy of this form of treatment for hyperhidrosis.
	Botulinum Toxin A (Botox® A): Intradermal injection of Botox for the reduction of sweating of the hands, feet and axillae has become an excellent option as a temporary effective and safe treatment. Its drawbacks include pain upon injection and possible diffusion and muscle paralysis in the treated area. The effect lasts only 4 – 12 months and injections have to be repeated. BOTOX is the treatment of choice for sweating of the hands, feet and forehead. It is effective for underarm sweating (axillary hyperhidrosis) but the new minimally invasive procedure, Liposuction & dermal curettage, has become the preferred method.