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Excessive Sweating

Excessive perspiration can be an extremely embarrassing condition, which can affect social and work place interactions but is now easily treated with Botox. Also called hyperhidrosis the condition mainly affects the underarms but in some people palms and feet can also be excessively sweaty.

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 $1430 for both armpits.

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.

Sweaty Armpits (Axillary Hyperhidrosis)

Axillary hyperhidrosis is excessive sweating of the underarms and is a common problem for men and women. Hyperhidrosis (excessive sweating) is a condition where your body produces more perspiration than is needed to cool the body and maintain appropriate body temperature. This means excessive sweating even in cool temperatures and without physical exertion. Stress can aggravate the condition, but the sweating can occur with or without stress.

Sweaty armpits are a problem that can lead to extreme anxiety and self-consciousness. Bromhidrosis or osmodrosis are related problems in which underarm odor, with or without excessive sweating, is the main problem. Many treatments have been trialled for hyperhidrosis with varying degrees of success. Two of the latest non-surgical, techniques are Botox and superficial liposuction.

Botox works by relaxing the muscles around the sweat glands so that the perspiration is not squeezed out onto the skin. This works extremely well for around 6-12 months and can be life changing for those with a significant problem.

Superficial Liposuction for Underarm Sweating

Superficial liposuction is a relatively new procedure for treating axillary hyperhidrosis, using a one-time process performed under local anaesthesia. Early data suggested this technique would provide permanent reduction in sweating from the armpits of around 85%. This process is similar to traditional liposuction which is used for the removal of excess fat in areas such as the abdomen or hips. The difference is that with “superficial” liposuction for hyperhidrosis, the cannula opening is directed toward the surface of the skin where the apocrine and eccrine (sweat) glands are located.

For the procedure itself, the area under each arm is numbed with a solution containing local anaesthesia. This is only mildly uncomfortable. The effect of the anaesthetic is immediate, so that once the area to be treated is anaesthetized, there is no further discomfort. Next, small openings are made at the edge of the areas to be treated. Usually two tiny incisions are made under each arm. A small cannula (metal tube) is then inserted through the incision. This cannula has an opening at its tip and is attached to a special syringe under vacuum pressure. The sweat glands are scraped and suctioned via a back and forth motion. The liposuction process takes approximately fifteen minutes per arm. This procedure is available at Palm Clinic for selected cases. We currently recommend Botox as the treatment of choice for most clients.

Sweaty Palms

Have you worried about sweaty palms when you need to shake hands?
For some people this can affect confidence and self esteem and lead to difficulties in the workplace. The problem can be treated with botulinum toxin which switches off the excessive sweating for on average of 3-6 months.

Treatments involve injecting between 50-100 units of Botox into each palm (and fingers) depending on how bad the problem is.  Most people start with 50 units per palm at a cost of $1430 for a total of 100 units or $1990 for 200 units.

Although similar treatment is available for the feet the results are much more variable because of the very thick skin in this area.  A minimum of 100 units per foot would be required at a cost of $1990 for 200 units.  We are much less keen to offer treatment for the feet because of the variability in duration, effectiveness and the high cost involved.

Sweaty Feet

Sweaty feet can be an extremely embarrassing condition which can be improved with Botox injections.
Botulinum 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.

Botox works particularly well for sweaty armpits and sweaty palms but the results for sweaty feet are much less predictable because of the thickness of the skin in this area.

Typically you would need at least 100 units of Botox per foot at a total cost of $1990 for two feet. Some people need even more than this and the duration of efficacy is very variable. For these reasons we only recommend treatment of sweaty feet in those people who are very distressed by the condition and are prepared to accept that despite the high costs the results are variable and can be disappointing in some cases.

Summary of Treatments 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 in the armpits but more typically 3-6 months for the palms. Botox is quick simple and effective and relatively painless. Contact Palm Clinic for an appointment to solve your excessive perspiration problems. Treatments cost $1430 to treat both underarms (50 units each side) and $1430-$1990 for the palms depending on whether we use 50 or 100 units per palm. Treatment takes around 20 minutes with a follow-up two weeks later if necessary.
  • 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. Topical therapy has been limited in success. Drugs have unpleasant side effects such as blurred vision, dry mouth and limited effectiveness on sweating.
  • 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.
  • Direct excision of affected skin creates unwanted and unsightly scarring often with prolonged recovery and limitation of mobility.
  • Treatment for excessive sweating of palms and feet is also possible with botulinum.

 

Botox and Dysport are Prescription Medicines containing 100 units of clostridium botulinum Type A toxin complex for injection. It is used for the treatment of severe frown lines of the face. It should be administered only by trained medical professionals. Arrange a consultation to discuss the benefits/risks of this procedure in appearance medicine. Cautions: people with defective neuromuscular transmission disorders, presence of infection at site of injection, glaucoma, pregnancy and lactation. Possible side effects include headaches, pain, burning or redness at injection site, local muscle weakness including drooping eyelids, lack of feeling and nausea. If you have side effects or concerns speak to a doctor. A charge applies. Note: Botox and Dysport treatment lasts about 4 months and after this time further courses of treatment could be necessary. Arrange a consultation to discuss your own situation.

1 Benedetto A. The Cosmetic Uses of Botulinum toxin type A. Int J Dermatol 1999, 38:6641.655