Hyperhidrosis (Excessive Sweating)
What is Hyperhidrosis?
Hyperhidrosis is the medical term for excessive sweating. Diagnostic tests are not required to formally diagnose the disorder. When patients complain of soaking through their clothes on a daily basis, even when not participating in activity or exercise, or having this problem impact their quality of life – a diagnosis of hyperhidrosis can be made. Although hyperhidrosis is not a dangerous disorder, it can be unpleasant and very inconvenient. Fortunately, doctors are learning more about this condition and how to effectively treat it.
People with hyperhidrosis have higher than normal levels of nerve stimulation of the sweat glands. This stimulation can be more or less continuous in some patients, or it can be intermittently active, triggered by heat, anxiety, or physical stimulation. Patients with hyperhidrosis often report other symptoms suggestive of high rates of sympathetic nerve activity: higher resting pulse rate, flushing of the skin, sensations of warmth, etc. No one knows why this increased nerve tone is present. There is clearly a genetic influence, however, as we frequently see groups of sweaters in the same family.
Sweat glands require stimulation by nerve fibers, which are part of the sympathetic nervous system. These fibers originate in the spinal cord and extend up to the undersurface of the skin where they branch into tiny fibers that extend to the sweat glands. Botox inhibits the release of a chemical messenger (acetylcholine), which is released at the nerve endings and is required to stimulate sweat glands. If there is no release of the chemical messenger, there is no stimulation of the glands. If there is no stimulation, the glands simply sit there doing nothing and the skin remains dry.
No. The effects of the Botox are strictly focal. Since only small surface areas are treated (axillary skin, palms, soles, upper forehead, etc.) the rest of the skin on the arms, legs, torso, and face sweats as before. The body has an internal mechanism to maintain normal body temperature.
We have successfully treated a number of patients who have sweating of the anterior scalp and upper forehead, although it is not as effective as axillary sweating. It is impossible to treat the entire scalp, therefore injections are usually restricted to the upper forehead, frontal and posterior scalp and neck.
Botox is a purified protein produced by bacteria. Minimal amounts of the medication are injected directly into the areas being treated. The Botox particle is too large to move from where it has been injected, therefore it cannot travel to other parts of the body. It has been widely tested and has been found to be extremely safe. There is RARE risk of allergic reaction.
The typical axillary (under arms) sufferer will be treated on both sides on the initial visit and 85 – 100% reduction in sweating is usually achieved with one treatment. Palmer (hands) patients are more difficult to treat and the results are not as successful. Feet are the most difficult to treat and the least effective. Both the hands and the feet are much more painful to treat and not as effective, therefore we usually recommend treating the underarms first before attempting to treat hands or feet.
Each vial of BOTOX® contains 100 units and the average dose for underarms is 1 – 2 vials. For most women and smaller men, 1 vial should be sufficient. For larger patients and those who are extremely active, 2 vials are recommended. Most patients will have 70 – 100% reduction in sweating that lasts anywhere from 6-12 months, although results may vary.
Hydrosal is a topical antiperspirant that contains aluminum salts that obstruct the sweat ducts at the skin’s surface to prevent excessive sweating. Treatment does not stop sweating; it simply traps the perspiration within the obstructed sweat duct. Most insurance companies require you to at least try this treatment before they will consider coverage of BOTOX® treatments. It should be applied to clean, dry skin nightly for 7 days and then 3-4 nights/week to maintain the results. These topical treatments can also be used in conjunction with Botox to extend your results, however some irritation can occur.
Iontophoresis for hyperhidrosis involves immersing each hand or foot in a tray filled with tap water. The trays are connected to a low-intensity electric current that is passed through the liquid. The currents are sent through the skin to disrupt the function of the sweat glands. The Drionic device must be purchased directly from an on-line source to be used at home. The results with these machines are varied and therefore we cannot recommend any particular brand. However, this may be an option to research and consider if your hands and feet are your primarily concern.
miraDry® is a procedure approved by Health Canada that uses safe and non-invasive technology to eliminate sweat glands in the underarm area. This provides a long-term soluation to excessive under sweat. Local anesthesia is administered to the underarms prior to the procedure and then controlled electromagnetic energy is delivered to the region where the sweat glands reside, which safely destroys the sweat glands without any surgical incisions or cuts.
Surgery which involves cutting or removing the overactive sweat glands is rarely performed as it is a highly invasive procedure that often is not effective or causes excessive sweating in other areas.
More information about hyperhidrosis can be found at: www.sweatmanagement.ca