Introduction Craniofacial hyperhidrosis is a disabling condition, likely caused by an overactive neural pathway. We describe clinical characteristics and response to Botulinum toxin A injections.

Method 17 patients with craniofacial hyperhidrosis were prospectively studied. Exclusion criteria included sweating secondary to autonomic disease or unilateral/localized/gustatory sweating secondary to diabetes or Frey Syndrome.

Results Three groups emerged:

1. Familial early onset, childhood to puberty, n=8 88% also suffered hyperhidrosis at axillae/palmar-plantar/back areas. 75% had positive family history. Males : females=1 : 1. Triggers included anxiety, heat and physical exertion.

2. Adult onset, 27–30 years, n=5 60% had isolated facial sweating. 80% had negative family history. Males : females=4 : 1. 100% had psychiatric comorbidity. Citalopram triggered sweating in one case.

3. Late adult onset, 50–65 years, n=4 100% had negative family history. Males : females=1 : 1. Systemic comorbidities were lupus, acromegaly, polymyalgia rheumatica. Sweating worsened at night and was unaffected by emotion.

Botulinum toxin A injections were well-tolerated with no significant side-effects and duration 4–12 months. Injection techniques will be demonstrated via video.

Conclusion Craniofacial sweating is a heterogeneous disorder. Three distinct groups are apparent. Botulinum toxin A injections are effective and well-tolerated.