Excessive sweating problems and their treatment

Sweating is a part of our life beginning from our childhood. We are familiar that prominent sweating occurs in hot environment, during heavy exercises, in some diseases, with emotional changes, under stress, in obese people and in some other conditions.

Body regulates inner temperature mainly by sweat glands with sweating. Sweat glands are millions in number and placed under the skin all over the body.

There are two types of sweat glands related to their product (sweat).

• Eccrine glands: They produce odorless and clear fluid. They are responsible for body temperature regulation. Eccrine glands are mainly concentrated in armpits, palm of the hand, sole of the foot, head and face.
• Apocrine glands: Their secretion is thick sweat. This secretion is manipulated by bacteria and final products create a well known body odor.  Apocrine glands are much more placed in armpits and genital area.

Excessive sweating may occur in some unusual and pathological conditions. It usually appears as generalized excessive sweating and in medical language called as secondary hyperhidrosis. Main causes of this type of excessive sweating are: infections, alcoholism, obesity, pregnancy, menopause and side effects of some drugs. Excessive sweating occurs on every part of the body and continues during sleeping. Treatment of secondary generalized hyperhidrosis is related to the cause. Infection or diseases should be treated and the drug causing this side effect should be terminated.

The second type of excessive sweating is a main concern in terms of aesthetics: Primary localized hyperhidrosis. This kind of hyperhidrosis is mainly seen in armpits, hand, food, head and face. Typically it happens on both sides that mean it is symmetrical and it stops during sleeping. The same condition might be present in other family members.

Primary localized hyperhidrosis begins in childhood or early adolescence and may continue for life. The reason is not known. Probably it is hereditary.  It impairs daily social life deeply. Having wet hands or armpits all the time is very annoying and embarrassing for most of the population. Wet and slippery hands may even create functional problems in hand work.

Treatment of primary (localized) hyperhidrosis:

Although no permanent solution is found for excessive sweating problems yet there are some treatment options which work on some body portions in some individuals. We can make a list of treatment from simple to more complicated:

• Antiperspirants: Antiperspirants are chemical material or drugs which applied topically onto the sweating areas. They create a mechanical plug into the holes of sweat glands so the sweat cannot be secreted out. There are many choices of antiperspirants with different strengths and action duration. Some products are sold freely in markets and some are sold in pharmacies by prescription. If they are used regularly they may reduce the sweating effectively in some individuals.
• OnabotulinumtoxinA (Botox®): In qualified hands botox injections may reduce sweating more than 50% in injection sites. Underarm areas, palms and soles are the most convenient places for botox treatment.  Reduced sweating may continue up to one year or more.

• Technological devices using electromagnetic energy: Microwave producing devices have been using for skin tightening. FDA approved to use some microwave devices for hyperhidrosis treatment. They can be used in office conditions and there are some reports about their beneficial effects in underarm areas. Although they are non invasive and easy to apply, their long term efficacy has not been proved yet.
•  Iontophoresis: Iontophoresis devices employ water and conduct mild electrical current through the skin surface. They are effective for hand and foot sweating. Some iontophoresis devices are available in the market for in-home using.
• Local surgery for armpit sweating: This treatment aims to remove or destroy the sweat glands in the underarm area. It can be done with liposuction from small incisions or can be done by opening the skin and removing the glands directly under vision.
• Thoracic sympathectomy: Cutting the sympathetic nerves at thoracic level effectively stops the sweating in the upper path of the body including hands. It is an invasive surgery. But doing the same job endoscopically will leave less scar. Endoscopic thoracic sympathectomy is called shortly as ETS. It is a serious and irreversible procedure with some unwanted effects and possible complications.

Prof. Dr. Ege Ozgentas prefers botox injections for the treatment of underarm hyperhidrosis.

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