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Abstract Hyperhidrosis (HH) is excessive sweating beyond what is necessary for maintenance of thermal regulation, in which patients sweat without any known etiology, such as rise in temperature or any mental stimuli. The sweating pattern is symmetric and can affect palms, soles, axillae, face and other areas. It has detrimental effects on patient’s quality of life, occupational activities and social interactions.The highest concentration of sweat glands is on the palms and the soles. Cholinergic stimulation of the sympathetic nervous system will activate postganglionic gray matter and nonmyelinated C fibers, consequently producing sweating from sudomotor effect. This understanding supports the concept of sympathetic block that has been advocated by some before any permanent sympathectomy is done. Also, for complete sympathectomy, excision of the ganglia as well as postganglionic fibers is crucial. Botulinum toxin is a naturally occurring protein produced by the bacteria Clostridium botulinum act by preventing the release of acetylcholine at the neuromuscular junction of striated muscle fibers, creating a flaccid paralysis of the muscle. BTX-A is now having an excellent role in the treatment of palmar and axillary hyperhidrosis, and certain types of headaches. |