HYPERHIDROSIS (SWEATY ARMPITS)

What is hyperhidrosis?

Hyperhidrosis, or excessive sweating, is a common disorder which can produce a lot of unhappiness. An estimated 2%-3% of people suffer from excessive sweating of the underarms (axillary hyperhidrosis) or of the palms and soles of the toes (palmoplantar hyperhidrosis). Underarm problems tend to start in late adolescence, while palm and sole sweating often starts early, around 13 years of age (on an average). If this problem is left untreated it may continue for the entire life.

Types of hyperhidrosis:

Localised symmetrical hyperhidrosis (primary hyperhidrosis) is the most common type of hyperhidrosis, this affects certain body sites (localized), and both sides equally (symmetrical). The palms, soles, underarm skin, face and scalp, or a combination of these, can be affected. The cause is not known. It usually begins in childhood or adolescence and may improve with age. This type of hyperhidrosis is also called focal or primary hyperhidrosis.

Generalised hyperhidrosis (affecting the whole body) can be caused by some illnesses including infections, and by hormonal conditions including the menopause, diabetes and an overactive thyroid gland. This type of hyperhidrosis is called secondary hyperhidrosis.

Sweating is embarrassing, it stains garments, ruins romance, and complicates business and social interactions. In some extreme cases, hyperhidrosis can make it difficult for a person to hold a pen, grip a car steering wheel, or shake hands.

What causes hyperhidrosis?

Although neurologic, endocrine, infectious, and other systemic diseases can on occasion cause hyperhidrosis, most cases arise in people who are otherwise healthy. Heat and emotions may also trigger hyperhidrosis in a few, however, many who suffer from hyperhidrosis sweat almost all their waking hours, regardless of their mood or the weather.

It is very common for excessive sweating to run in the family. In addition to this, the products which you use like alcohol, cigarettes, caffeine, prescription drugs, illegal drugs and greasy foods may also cause excessive sweating.

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What is the treatment options for hyperhidrosis?

Many people with this annoying disease can achieve good results and improved quality of life by a detailed systematic evaluation of causes and trigger of excessive sweating and following a stepwise treatment to cure it.

The approach to treating excessive sweating is as follows:

  1. Over-the-counter antiperspirants - These normally contains a low dose of metal salt (usually aluminum) are usually the first line of treatment option because they are easily available. Antiperspirants containing aluminum chloride may be more effective when other antiperspirants have failed.
  2. Prescription strength antiperspirants - These normally contain aluminum chloride hexahydrate.
  3. Iontophoresis -  In this technique, a device is used which passes ionized tap water through the skin using direct electricity.
  4. Anticholinergics -  These are oral medications which can reduce sweating.
  5. Botulinum toxin - Botulinum toxin injection can be given under the arms to treat excessive axillary sweating.
  6. Lasers - Lasers can target and kill the underarm sweat glands.
  7. Surgery - A procedure called thoracic sympathectomy may be considered as a last resort.

Botulinum toxin injection for sweaty armpits

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Botulinum toxin injection treatment for hyperhidrosis

Botulium toxin injection can be given under the arms to treat excessive axillary sweating. Botulinum toxin is a natural purified protein which has the ability to temporarily block the secretions of the chemical which can "turn on" the body's sweat glands.

The injection is given as an out-patient procedure just below the surface of the skin. The effect of injection lasts for a period of 3 to 6 months. Patients request such treatment during warm or hot weather

This treatment is very effective and can cause up to 82-87% decrease in sweating. The results of the injection can be seen in 2 to 4 days after the treatment with the full effects usually noted within 2 weeks.

In case of excessive hand sweating (palmar), botulinum toxin is about 80-90% effective. The injection treatment in the hands may cause a temporary pain and weakness in hands.

Procedure:

A very fine needle is used to inject a small amount of botulinum toxin just beneath the skin intermittently throughout the area of excessive sweating (in a grid pattern, approximately 1 to 2cm). It is necessary to follow-up healthcare provider in 1 to 2 weeks after the botulinum toxin injection.

Cost of botulinum injection

The cost of botulinum toxin injection is from £250 for a single area at MACS clinic.

SELF CARE (WHAT CAN YOU DO?)

In case any treatment is not possible or is unsuccessful, there are numerous ways which can help you.

  1. Try to avoid situations which can trigger sweating such as hot places or rushing about.
  2. Alcohols and spicy and oily food can also start an episode of hyperhidrosis. Try to avoid them in order to avoid excessive sweating.
  3. Absorbent underlayers such as T-shirts and adhesive absorbent underarm pads can help hyperhidrosis of the body.
  4. Loose fitting clothes made of natural fibres and leather shoes are beneficial. Changes of clothes may be necessary during the day.
  5. If your feet are the main problem, you may need to change socks and shoes during the day. You may be able to slip your feet out of your shoes even for short periods. You should have several pairs of daytime shoes so that each pair has a few days to dry out. There are many good, absorbent insoles available that will also help.
  6. It is best to avoid soap-based products and to use an emollient instead.
  7. Silver and copper socks are also helpful for many.
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