Primary hyperhidrosis is a disorder of excessive sweating which may effect any part of the body, most commonly the axillae (armpits), palms of the hands, soles of the feet, and forehead. The condition is long-lasting and of unknown cause.
It has been realised for some time that the injections of certain medications has a blocking effect on the sympathetic nerves which supply the sweat glands, and in the last 10 years, studies have confirmed positive outcomes for this treatment of hyperhidrosis.
Another option is Dermatosuction which involves removal of axillary sweat glands through tiny incisions in the skin.
Treatment by Injections
How does this treatment work?
This treatment inhibits the neurotransmitter that is responsible for sweat production. This reduction is generally at least 50% in the majority of patients.
The nerves do eventually recover, with a return of previous sweat production. The duration of the effect varies from 3 to 18 months, with the usual length of action 6 to 12 months. Re-treatment may then be performed to maintain the reduction in sweating.
How is the treatment performed?
Injections are made in a series of evenly placed small injections into the skin under the arm. In some cases, this area can be delineated more clearly by the use of a combination of iodine paint and starch applied to the skin. In many cases though, this is unnecessary, and your doctor will simply map out the area to be treated with a skin marker pen.
In the axilla, some 20 or so injections are performed for each side. If desired, local anaesthetic (EMLA) cream can be applied to the skin to reduce the sensitivity prior to injection.
Is it safe?
This therapy has an excellent overall safety record. The small doses used for treatment of hyperhidrosis present no risk to the body in general.
Does it work for everyone?
No. About 2% of patients have pre-existing antibodies to the injected chemical. Unfortunately, there is no way of identifying this small group of people beforehand.
Are there any side effects?
In the treatment of hyperhidrosis there are some possible side effects which you should be fully aware of.
These include:
- Bruising. This is temporary.
- Pain. This passes quickly.
- Increase in sweating in other areas (occurs in 4% of cases). Usually less problematic than in other forms of treatment for hyperhidrosis.
Costs
The fee for the treatment is $1200.
Currently there is no medicare rebate for this treatment.
Axillary Dermatosuction
Dermatosuction is a procedure that involves using liposculpture techniques to reduce the number of glands producing sweat in the armpits.
It has a big advantage over methods such as injections in that it lasts much longer and may even be permanent. Results to date show benefits lasting at least 3 years.
What is involved?
The area is marked out (pic on left) and numbed with a
local anaesthetic solution. (central pic) Tiny punctures are made at the edges of the treatment area and through these incisions a liposculpture cannula 2 to 3 mm in diameter is inserted.
The cannula is passed through the upper subcutaneous fat and deeper skin layers to remove as many sweat glands as possible (pic on right).
The procedure may take up to and hour and a half.
Afterwards the area is dressed and the patient goes home.
Antibiotics are generally given to prevent infection.
Photographs courtesy of Dr Ron FeinerWhat sort of changes should I expect?
The aim of this treatment is to reduce the amount of sweating from excessive and socially embarrassing levels to a "normal" or socially acceptable level. There will always be individual variations in results, but generally the following pattern is seen.
there is an initial drop in sweating, and this may even be experienced as a total absence of sweating. After a period of weeks to months level tend to increase and there may be a period of rebound sweating in which the patient returns to pretreatment levels. This is a temporary phenomenom and leads into a more stable "normal" sweating level. It is important to remember that we all increase our amount of sweating when hot, stressed or physically active. This state is normal and will occur post treatment.
The key point to keep in mind is that we are aiming for a normal pattern of sweating, and not an absence of sweating.