Excessive Sweating [Hyperhidrosis]

Excessive perspiration can be an extremely embarrassing condition, which can affect social and work place interactions but is now easily treated with Botox.

Clothing can be quickly stained and thousands of dollars spent on dry cleaning and replacement of clothing.  Sweaty palms can cause anxiety in social and workplace environments.

The modern solution for excessive sweating (hyperhidrosis) is BOTOX™
Botox is a natural purified protein, which works by preventing the presynaptic release of acetylcholine in sympathetic nerve endings associated with the eccrine sweat glands. In other words they stop the muscle surrounding the sweat gland from squeezing out the sweat. Palm Clinic in Auckland, New Zealand has a team of expert doctors who specialise in Botox treatment for excessive sweating. The treatment costs a total of $1400 for both armpits and $1900 for both palms.

The Cause of Excessive Sweating
Hyperhidrosis is caused by over activity of eccrine sweat glands in the skin. The eccrine glands exist in various concentrations throughout the skin. They maintain body temperature within a narrow range in the face of external heat, or increase in physical activity.

Eccrine sweat evaporates on the surface of the skin and effects a transfer of heat, primarily by direct conduction from the vascular supply to the skin.

Sweating can reach volumes measured in litres per hour.

Although the glands are normal, there is an abnormal neurologic response to stimuli in the hypothalamic sweat centres. The eccrine sweat glands are concentrated in the palms, soles and under the armpits (axillae), and number around 2-4 million per person.

Surrounding the eccrine glands are myoepithelial cells, which contract on stimulation from the sympathetic nerves. These nerves utilise acetylcholine as their neurochemical transmitter at the nerve endings. This is where the Botox works. Higher cortical functions in the brain (anxiety, stress etc) together with thermal stress induced by heat or exercise results in stimulation of the glands directly.

Treatment for Excessive Sweating
Botox. Botox is administered through a very fine needle into the affected skin. Sweating diminishes substantially within 48 hours and results can last from 6-12 months. Botox is quick simple and effective and relatively painless. Contact Palm Clinic for an appointment to solve your excessive perspiration problems. Treatments cost around $1400 to treat both underarms and the treatment takes around 20 minutes with a follow-up two weeks later.  The palms are more painful to treat and need a combination of anaesthetic cream and ice or nerve blocks.  The palms also need more Botox thus increasing the price to $1900.

Liposuction of the axillae (armpits): Because the sweat glands are very close to the under surface of the skin, the glands can potentially be removed permanently by liposuction. This is a new technique which can be performed at Palm Clinic. There is only one good international study at present with claims of 80-90% permanent reduction in underarm perspiration. Our early experience has produced positive feedback and we will update our knowledge as we perform more of these procedures.

Traditional Treatment for Excessive Sweating
Traditional dermatology therapies have included aluminium salts used in cosmetic antiperspirants, iontophoresis or drugs such as glycopyyrolate. Human sweat is largely odourless but bacteria on the skin reacts with the sweat to create the odour.  Deodorants work by temporarily killing bacteria and masking the odour with a fragrance whereas antiperspirants work by plugging the sweat gland usually with compounds that are an aluminium salt.

Endoscopic sympathectomy involves cutting the sympathetic nerves that supply the sweat glands. This is performed through keyhole surgery and usually takes a few days to recover from strong flu-like symptoms.  Compensatory sweating from other parts of the body after treatment can be a problem. Sympathectomy has a recognised complication rate including Horner’s syndrome, pneumothorax and injury to nerves.

Topical therapy has been limited in success. Drugs have unpleasant side effects such as blurred vision, dry mouth and limited effectiveness on sweating.

Direct excision of affected skin creates unwanted and unsightly scarring often with prolonged recovery and limitation of mobility.