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Armpit Hyperhidrosis or excessive underarm sweating.

Around one in 100 adults suffers from hyperhidrosis, excessive sweating, the most common cause is an over reaction to heat by the body's sweat glands. Two kinds of hyperhidrosis have been identified primary and secondary.

Primary hyperhidrosis starts around adolescence or even earlier and has a strong inherited factor unlike secondary hyperhidrosis which can begin at any age and be a symptom of underlying medical problems such as disorder of the thyroid or pituitary gland, diabetes mellitus, gout, menopause, certain drugs, or mercury poisoning.

Why we sweat

Sweating is the body's cooling mechanism and is essential to everyday life. Across the skin are some 2 - 5 million eccrine sweat glands which produce thin, salty sweat. This sweat doesn't smell. But, in hairier parts, such as the armpits and groin, there are apocrine sweat glands which release stronger sweat. This contains fatty acids and other substances that bacteria like to feed on, and it is these microbes, not the sweat itself, which makes people smell if they don't wash regularly.

Everyone has a different threshold for acceptable sweating. Some are embarrassed at the faintest 'glow', while other soldier on with shirts and socks that are wringing wet. Champion sweaters lose about 10ml of fluid an hour from their armpits, and dermatologists see people whose hands get so sweaty that they cannot hold a glass of wine.

Areas likely to be affected

Sweat busters

Zinc salts are the drying agents in most antiperspirant deodorants. They dissolve in the sweat to form plugs which block the pores and reduce the amount of sweat that is released.

Drugs can be used to switch off sweat glands but they make other glands dry up too, for example, in the mouth.

Some severe cases undergo surgery to remove sweat glands or destroy the nerves that stimulate sweat production but results can be disappointing. The great advantage of Botox is that the effects are temporary and wear off over 9 months.

Botox treatment

Botox treatment for sweating typically involves about 12 small injections to each armpit. The best sites for the injections are identified by swabbing the armpits with iodine and dusting them with powder to see which areas are sweatiest.

Ms Kavouni advocates topical anaesthetic cream so the tiny needle jabs are not felt. The toxin blocks messages from the nerves to the sweat glands. So even if the nerves are telling the glands to release sweat, they don't respond.

In skilled hands, the injections knock out enough sweat glands to get rid of embarrassment, but leave sufficient working to ensure that normal sweating/cooling continues. Intriguingly, there is evidence to suggest that Botox reduces body odour too, but no one is quite sure why.

Ms Kavouni is reluctant to perform feet and palm Botox treatments as these areas are very sensitive and the therapy can become quite uncomfortable.

For more information contact the UK hyperhidrosis support group: www.hyperhidrosisuk.org