Primary focal
hyperhidrosis is a disorder of idiopathic excessive sweating that typically affects the axillae, palms, soles, and face. The disorder, which affects up to 2.8% of the US population, is associated with considerable physical, psychosocial, and occupational impairments. Current therapeutic strategies include topical
aluminum salts, tap-water iontophoresis, oral
anticholinergic agents, local surgical approaches, and
sympathectomies. These treatments, however, have been limited by a relatively high incidence of adverse effects and complications. Non-surgical treatment complications are typically transient, whereas those of surgical
therapies may be permanent and significant. Recently, considerable evidence suggests that
botulinum toxin type A (BTX-A)
injections into hyperhidrotic areas can considerably reduce focal sweating in multiple areas without major adverse effects. BTX-A has therefore shown promise as a potential replacement for more invasive treatments after topical
aluminum salts have failed. This article reviews the epidemiology, diagnosis, and management of primary focal
hyperhidrosis, with an emphasis on recent research evidence supporting the use of BTX-A
injections for this indication.