Excessive sweating, also known as Hyperhidrosis, refers to frequent or constant excessive sweating. Some individuals sweat more than what is typically needed to cool down the body, a condition that affects nearly 3% of Americans. Hyperhidrosis occurs when the sympathetic nervous system, which controls sweat production, goes into overdrive and causes the sweat glands to produce more sweat than usual. Common areas of the body that are affected by hyperhidrosis include the underarms, palms, and face.
Primary hyperhidrosis refers to body stimuli that trigger excessive sweating, while secondary hyperhidrosis refers to hyperhidrosis that is associated with an underlying medical condition, such as infection, neurologic or endocrine disorders, and spinal cord injury.
Treatment options available to patients with primary hyperhidrosis can be categorized as non-surgical (topical antiperspirants, iontophoresis, systemic medication and Botox injections) or surgical (LaserDry, excision of axillary tissue, endoscopic thoracic sympathectomy (ETS)). The therapeutic alternatives also differ by duration of efficacy, side effects, and response rate in the various anatomic areas treated. LaserDry should be the first choice for the axillary hyperhidrosis.
LaserDry is a revolutionary treatment option for primary axillary hyperhidrosis, involving a procedure in which the eccrine sweat glands are subdermally and thermally ablated and destroyed from the armpit area.
Dr. Shu developed this procedure using a combination of subdermal laser or Vaser ablation, mechanical curettage, and suction disruption of the axillary sweat glands. Similar to small scale liposuction, this procedure is performed painlessly using tumescent local anesthesia. Typically, the patients need only one LaserDry treatment with the result of an 80% to 90% improvement; some patients have found that the maximum sweat reduction may take several months after the procedure. If sweat reduction has not been sufficient, it is possible to repeat the procedure, but this is rarely necessary.
Botox is a product from the clostridium botulinum type A bacteria which produces a natural toxin. Botox finds use in a wide range of medical as well as cosmetic fields. With hyperhidrosis, Botox typically works by blocking the nerve endings of the sympathetic nervous system and preventing the release of a chemical called acetylcholine that dictates sweat production and thereby controls excessive sweating. The FDA has approved the use of Botox to treat primary axillary hyperhidrosis or severe underarm sweating.
Botox provides relief from excessive underarm sweating for at least six months. The original study showed 81% reported more than a 50% reduction in sweating in 322 patients. And 50% of the patients reported an alleviation of excessive underarm sweating for nearly seven months.
The procedure of injecting Botox
Typically Botox injections are intradermally administered using a very thin needle under the skin of the underarms. A patient will sometimes continue to experience sweating in the affected area if the initial injections missed a few sweat glands. In that case a top-up dose of additional injections may be required. In any event the procedure is virtually painless requires 15 minutes.
Botox injection for primary axillary hyperhidrosis should not be viewed as a cure. It is simply an option to relieve the discomfort associated with excessive sweating. Therefore the patient has to go back to the physician’s office for a repeat dose of Botox every six to 10 months. However Botox treatment by itself doesn’t cause permanent damage to an individual’s system and a patient can go in for as many doses as required provided the intervals between the doses is strictly controlled.
Up to 10% of patients may develop influenza-like symptoms such as low grade fever, mild throat and headache. Very few patients repored anxiety compensatory sweating (perspiration in areas other than the one injected) neck and back pain and itching. The localized pain and mild bruising after injections happen occasionally. Botox is also not recommended for the treatment of pregnant or breastfeeding women.