Hyperhidrosis (Excess Sweating)

Overview

Hyperhidrosis is the excessive production of sweat.

Approximately 2-3% of the population suffers from excess sweating, also known as hyperhidrosis. Usually localized to the armpits, palms or soles of the feet this condition can have significant social implications for those affected.

What is the most common form of Hyperhidrosis?

Primary Focal HyperHidrosis (PFHH) is the most common form of hyperhidrosis and is defined as excessive sweating, not caused by physical activity, that appears symmetrically in a localised fashion. It may be an inherited condition that usually appears in adolescence, but it can also begin in childhood or even in infancy.

PFHH most frequently affects the underarms, hands and feet. While it does not endanger the life or physical health of the individual, it can have a significant negative impact on the quality of life and cause difficulty with work, school and social relationships.

What should I do in order determine the exact nature of my condition?

There are several steps you need to take initially to help determine the exact nature of your condition:

  1. You should have your Consultant Plastic Surgeon ensure that the excess sweating is not being caused by any underlying condition like menopause, obesity, a metabolic disorder or nerve damage. Sometimes an overactive thyroid can account for generalized excess sweating as well as some medication. These are all considered secondary hyperhidrosis. Treatment for secondary hyperhidrosis begins with treating the underlying condition.
  2. You also need to determine if the sweating is ‘generalized’ (all over the skin surface), or ‘focal’(confined to one area) like the armpits, soles of your feet, face or the palms of your hands. Most sufferers of focal hyperhidrosis (approximately 50%) have excess sweating in their armpits.
  3. If your excess sweating just occurs in one area, that is considered focal hyperhidrosis. This condition often comes on suddenly and unfortunately little is known of its cause.

What are the main treatment options for Hyperhidrosis?

The main treatment options include the following:

a. Antiperspirant: Patients should usually start with trying a strong antiperspirant solutions applied to the underarms or palms. These can be effective, but can also cause irritation.
b. Botulinum Toxin Type A can be injected just under the skin to block the release of acetylcholine, which activates the sweat glands. A special starch / iodine test is often performed to first identify the area of maximum sweat gland activity. It is usually effective for 6-8 months. The use of various local anaesthetic techniques minimizes the discomfort of the injections.

The use of Botulinum Toxin Type A, the second option, is detailed below:

What happens during the Treatment?

This treatment is relatively quick and will usually take only 10 to 15 minutes. The injection site is usually numbed by application of a topical anaesthetic approximately 15 minutes prior to the treatment.

Relatively large volumes (compared to facial volumes) of Botulinum Toxin Type A are injected by a needle with a small gauge into the muscle or muscle area over a short period of approximately 20 seconds.

The contractions of the area treated can be greatly reduced thus eliminating wrinkles. The insertion of the needle should only provide a tiny pin prick sensation as a very small gauge, or needle size, is used.

The effect is usualy noticed after two to five days and should last from three to six months. The effects of subsequent injections may be slightly longer.

What happens after the Treatment?

You will be advised to abstain from touching or massaging the injection area for 24 hours. The anaesthetic is purely localised and you can return to work immediately.

You will need to repeat this treatment for optimum outcomes every 4-6 months.

What are some of the Potential Complications and Side Effects?

The use of Botulinum Toxin Type A has been studied very widely with numerous independent studies supporting it’s general efficacy and safety. A number of studies have confirmed the side effects to be minor and temporary in the vast majority of applications. Significant and medium to long term complications are very rare, and serious side effects are uncommon.

Some of the reported side effects include:

  • Flu like symptoms.
  • Muscle weakness.
  • Droopy eye (ptosis),
  • Photosensitivity.
  • Slight bruising around the injection site

For additional information regarding this procedure please contact your Consultant Plastic Surgeon.