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Excessive Sweating

Excessive Sweating or Hyperhidrosis can be a very embarrassing, uncomfortable, and at times disabling condition. Hyperhidrosis affects millions of people around the world. There are estimates that up to 3% of the population suffer from this condition. Because of lack of awareness, the majority of these patients are never diagnosed or treated.

The good news is that there are several different options available for treatment of excessive sweating. Every one who is afflicted by this problem (underarms, hands and feet) should ask a physician for evaluation. Simpler and noninvasive options should always be tried first.

Dr. Soltanian has extensive experience in treatment of peripheral nerve problems and liposuction which allows him to treat excessive sweating of the axillary and hand region in a safe and effective manner. He offers Botox™ injections, direct surgical excision and subdermal liposuction for hyperhidrosis.


Topically applied antiperspirants are the first line of treatment. They are available either over-the-counter or by prescription.  The main ingredient is commonly a metallic salt (E.g. Aluminum chloride) in various concentrations. Antiperspirants work by blocking the sweat ducts which reduces the amount of sweat excreted by the glands. They are used for sweating of the underarms, feet, hands, and sometimes the face.


Iontophoresis is used for cases of excessive sweating which do not respond to treatment with antiperspirants.  It is usually used for hands and feet.

A mild electric current is conducted through water through the skin. This current, along with the mineral particles in the water cause microscopic thickening of the outer layer of the skin which can block the flow of sweat to the surface.  At the beginning of the treatment the process is repeated every other day for five to 10 days or until the sweating is reduced to the desirable level.  During the procedure the feet, hands or both are placed in shallow containers of water for short period of time between, 20 to 40 minutes.  After achieving the desired level of sweat reduction, a maintenance program ranging from one treatment per week to once every four weeks will be established and modified based on patient's response.  Iontophoresis is not indicated in pregnant women, and patients with electronic implants (e.g. pace maker) and large implanted metallic objects (e.g. Joint replacement). 


The United States Food and Drug administration (FDA) approved the use of Botox™ (botulinum toxin type A) for treatment of refractory axillary hyperhidrosis in 2004.  Studies have shown that the use of botulinum toxin is safe and effective in reduction of the underarm sweating.  The effect can last around seven months and sometimes longer.  Botox™ interrupts the transmission of signals between the nerves and the sweat glands causing a reduction in sweat production. The injections can be performed in the physician's office.  There is no significant recovery time.

First the area of excessive sweating is visualized and marked using the starch and iodine method.  Then the medication is injected with a very fine needle in a grid pattern covering the area of the skin containing the sweat glands.  The injections are usually well tolerated. However, topical anesthesia and nerve blocks are also available. Botoxinjections do not cure excessive sweating permanently.  The symptoms will return gradually as the nerve blockage wears off. Some health insurance companies cover the costs of Botox™ treatment for hyperhidrosis.

Local resection

Local resection of tissue from axillary area can be an effective treatment for hyperhidrosis. The tissue underlying the skin which contains the sweat glands can be excised.  This procedure is performed under local anesthesia or minor sedation.  Prior to the procedure, the area of the skin containing the sweat glands is marked. Through an incision in the axillary area the tissue underneath the skin is removed. This layer contains the majority of the sweat glands.  Patients need a short period of time for recovery after this procedure.

Subdermal Liposuction

Similar to the open surgical procedure, the goal of this treatment is to remove the tissue underneath the surface of the skin which contains the majority of the sweat glands. This is achieved by performing very superficial liposuction. A small metal cannula is introduced underneath the skin through a very small incision in the axillary area. The tissue is suctioned through the cannula.  This procedure can be performed under local anesthesia and mild sedation. Subdermal liposuction has been shown in clinical studies to reduce the amount of sweat production.

Endoscopic Thoracic Sympathectomy (ETS)

This method is reserved for patients who have not had good results with other treatment modalities.  This procedure is performed by specialized thoracic surgeons utilizing endoscopic instruments.  During this procedure the nerve paths associated with excessive sweating are interrupted in the chest cavity.  This treatment can frequently have serious and irreversible side effects such as compensatory sweating.  ETS should be considered as a last resort treatment.






Excessive Sweating

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