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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.
Antiperspirants:
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:
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).
Botox™
injections:
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. Botox™
injections 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.
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