Botox is approved for the treatment of hyperhidrosis in the United States. It is injected intradermally to treat hyperhidrosis and inhibits the release of acetylcholine at the neuromuscular junction and from the sympathetic nerves that innervate eccrine sweat glands.
When performed correctly, patients have little pain or discomfort. Proudly at MSI, a newer bipolar RF device effectively reduces the amount of sweating. The new bipolar microneedles radiofrequency device can destroy the eccrine glands by thermolysis at the deep dermis and subcutis interface while minimizing damage to the surrounding tissue.
Fractional radiofrequency treatment is a new safe, and effective alternative for mild to moderate primary axillary hyperhidrosis. Prof Moawad suggests repeated sessions of fractional radiofrequency to achieve a complete response. When medical treatment fails, he will offer ultrasound and power-assisted armpits liposuction to remove sweat glands gently.
Signs and Symptoms of Excessive Sweating (Hyperhidrosis)
The word “hyperhidrosis” means too much (hyper) sweating (hidrosis). Excessive sweating happens when a person sweats more than is necessary. Yes, it’s essential to sweat. Sweating cools the body, which prevents us from overheating — people who have hyperhidrosis, however, sweat when the body does not need cooling. Many people who have hyperhidrosis sweat from one or two areas of the body. They often sweat from their palms, feet, underarms, or head. This excessive sweating can interfere with everyday activities.
- Visible sweating: When you are not exerting yourself, do you often see beads of sweat on your skin or have sweat-soaked clothing? Do you sweat when you’re sitting? If you have this medical condition, you may notice:
- Sweating interferes with everyday activities: Does sweating cause difficulty holding a pen, walking, or turning a doorknob? Does sweat drip slowly onto your papers or computer?
- The skin turns soft, white, and peels in specific areas: Does your skin stay wet for extended periods?
- Skin infections: Do you get frequent skin infections on the parts of your body that sweat heavily? The athlete’s foot and jock itch are common skin infections.
What are the Types of Excessive Sweating (Hyperhidrosis)?
Primary Excessive Sweating (hyperhidrosis)
In one or a few areas of the body: “Focal” means that excessive sweating (hyperhidrosis) affects one or a few parts of the body. The areas of the body most affected are the underarms, hands and feet, and forehead.
- On both sides of the body: If excessive sweating occurs in the underarms, the person usually notices both underarms sweat excessively. The same holds for the hands and feet.
- After waking up: Sweating may begin soon, but the person usually does not notice damp sheets or wet clothing unless the room is hot.
- At least once a week: It occurs much more often for many people.
This type of hyperhidrosis usually begins when the person is a child or adolescent. Most people who have this type are otherwise healthy. The word “primary” means that the cause is not another medical condition in medical terminology.
The exact cause of primary hyperhidrosis is not known. Some recent studies point to a genetic basis, as it appears to run in members of the same family. Even though stress and anxiety can trigger sweating episodes, primary hyperhidrosis is not classified as a mental condition.
Secondary Excessive Sweating (Hyperhidrosis)
In medical terminology, “secondary” means that excessive sweating (hyperhidrosis) has an underlying cause. The cause could be a: medical condition or a side effect of taking medicine or food supplement. Medical conditions that can cause excessive sweating include diabetes, frostbite, gout, Injury (such as head trauma caused by accident), menopause, obesity, overactive thyroid (hyperthyroidism), or tumor. If a person has this type of hyperhidrosis, the person may notice:
- The entire body sweats excessively: Sometimes, only parts of the body sweat.
- Sweating occurs during sleeping: If you sweat excessively while asleep, it is crucial to see a dermatologist to learn why this happens.
This type of sweating usually begins when the person is an adult. It also may start after an accident or frostbite. Many medicines also can cause this type of hyperhidrosis. Both kinds of hyperhidrosis can cause people to feel highly anxious and embarrassed. Students often avoid raising their hands during class. Many teens never date. Adults may hide sweat stains by wearing layers of clothing or frequently changing throughout the day.
Who gets Body Odor and Excessive Sweating (Hyperhidrosis)?
Dermatologists estimate that 3% of people in the United States have excessive sweating. People of all races get hyperhidrosis. Excessive sweating can begin at any age. Researchers have learned that most people have one of the following:
- Have a family member who sweats excessively.
- Have a Medical condition that causes sweating?
- They are taking medicine or food supplements, which can cause excessive sweating.
- People who sweat too much, such as those with hyperhidrosis, may also be susceptible to body odor.
How Do Dermatologists Diagnose Excessive Sweating?
To diagnose this condition, a dermatologist gives the patient a physical exam. This includes looking closely at the areas of the body that sweat excessively. A dermatologist also asks questions. This helps the doctor understand why the patient has excessive sweating. Sometimes medical testing is necessary. Some patients require a test called the sweat test. This involves coating some of their skin with a purple powder when the skin gets wet. More medical tests are needed to discover an underlying medical condition.
What Are My Treatment Options for Excessive Sweating?
This may be the first treatment that a dermatologist recommends. It is affordable. When applied as directed, an antiperspirant can be helpful. Your dermatologist may recommend a regular or clinical-strength antiperspirant. Some patients need a stronger antiperspirant and receive a prescription for one. The antiperspirant sits on top of your skin.
As you sweat, the antiperspirant is pulled into your sweat glands. This plugs the sweat glands. When your body senses that its sweat glands are occluded, this should signal your body to stop producing so much sweat.
Iontophoresis (the no-sweat machine) for Excessive Sweating (Hyperhidrosis)
If excessive sweating affects your hands, feet, or both areas, this may be an option. You will use this treatment at home. It requires you to immerse your hands or feet in a shallow pan of tap water. A medical device sends a low-voltage current through the water as you do this. The electric current shuts down the treated sweat glands temporarily. Most people need about 6 to 10 treatments to shut down the sweat glands. To get improvement, you begin by using the device as often as your dermatologist recommends.
At first, you may need 2 or 3 treatments per week. A treatment session usually takes 20 to 40 minutes. Once you see results, you can repeat the therapy as necessary to maintain results. This can range from once a week to once a month. If this treatment is right for you, your dermatologist will teach you how to use the device and give you a prescription so that you can buy one. Some patients also receive an order for medicine that they add to the tap water.
Prescription medicine for Excessive Sweating (Hyperhidrosis)
Some patients receive a prescription for a drug that temporarily prevents them from sweating. These medicines work throughout the body. These medicines prevent the sweat glands from working. Athletes, people who work in a hot place, and anyone who lives in a warm climate should use extreme caution when using this treatment. The body may not be able to cool itself.
Proudly at MSI, a newer bipolar RF device effectively reduces the amount of sweating. The combination of RF and fractional microneedle technology termed fractional radiofrequency creates an effective method with a better safety profile for treating various dermatologic conditions.
New bipolar RF devices can destroy the eccrine glands by thermolysis at the deep dermis and subcutis interface while minimizing damage to the surrounding tissue. Fractional radiofrequency treatment is a safe and effective alternative for moderate to severe primary axillary hyperhidrosis. Prof Moawad suggests repeated sessions of FR be considered to achieve a complete response.
Excessive Sweating Treatment. Microwave Device (miraDry)
Microwave devices (miraDry), although not commonly used in dermatology, can be optimized to focus heat at the interface between the skin and subcutaneous tissue and cause irreversible thermolysis of apocrine and eccrine sweat glands that reside at that interface. miraDry uses a non-invasive handheld device to deliver precisely controlled electromagnetic energy beneath the underarm skin to the specific area where sweat glands are located, resulting in thermolysis (decomposition by heat) of the sweat glands.
While the sweat glands are being eliminated through electromagnetic technology, the top layers of the skin are simultaneously cooled and protected. Sweat glands do not grow back after treatment, so the effect can be seen almost immediately, with lasting results. The mechanism of action of the procedure causes non-invasive focused heating of the tissue at a depth of the sweat glands with the resulting thermolysis of the sweat glands. However, it cannot use to treat excessive sweating in other areas such as hands or feet because the procedure has been optimized to consider the physical attributes of the underarms.
Excessive Sweating Treatment. Botox Injections
Botox is approved for the treatment of hyperhidrosis in the United States. It is injected intradermally to treat hyperhidrosis and inhibits the release of acetylcholine at the neuromuscular junction and from the sympathetic nerves that innervate eccrine sweat glands. Your dermatologist can inject a weak form of this medicine into your underarms.
To treat excessive sweating, a patient will need to have very tiny amounts injected into many areas of the underarms. When performed correctly, patients have little pain or discomfort. Findings from some research studies suggest that this treatment may be helpful for other areas of the body. It may help post-menopausal women who sweat excessively on the head. It may be helpful for excessive sweating that affects the hands and feet.
Excessive Sweating Treatment. Surgery
A surgical operation is an option for people who have not been helped much by other treatments or if other therapies cause unacceptable side effects or problems. Surgical ablation of eccrine glands is the only way to eliminate or reduce axillary osmidrosis and hyperhidrosis permanently. Of the various surgical treatment modalities, ideal methods should have a high success rate, few complications, little or no scarring, and short recovery time. Local surgical treatment for Axillary hyperhidrosis can be divided into three broad categories:
- (i) excision of subcutaneous glandular tissue only without skin removal.
- (ii) excision of skin with its glandular tissue attached; and
- (iii) selective sweat gland ablation using superficial, ultrasonic, laser, radiofrequency and power-assisted liposuction. Both sweat glands (eccrine and apocrine) are scraped from the undersurface of the axillary skin with the help of previous technologies through a small hole cut in the skin. This gives superior results with less risk of complications.
Ultrasound Power-Assisted Tumescent Liposuction with Curettage
Tumescent liposuction combined with curettage is preferred over simple tumescent liposuction alone. Superficial liposuction could remove only the subcutaneous fat. It could not remove the apocrine gland’s dermal tissue, so treatment by liposuction, combined with curettage, ultrasound, or laser, has been developed and reported to be active and safe. Ultrasonic assisted liposuction (UAL) is any modified liposuction technique that delivers ultrasonic energy to subcutaneous fat to facilitate traditional negative-pressure liposuction.
There are two types of UAL: Internal UAL and external UAL. Internal UAL delivers ultrasonic energy directly to subcutaneous fat by a metal rod or cannula inserted through an incision in the skin. VASER is a third-generation ultrasound-assisted liposuction tool that provides power in pulses through a specially designed probe. Pulsating energy and the specially developed probe helps to prevent overexposure to ultrasonic waves and the subsequent side effect. After introducing internal ultrasonic-assisted liposuction (UAL), reports of a higher incidence of complications such as skin necrosis and seromas tempered patients and physician enthusiasm for internal UAL.
The consequence has been a new interest in testing the application of external ultrasound before liposuction. The use of external ultrasound before liposuction is a technique that requires the transcutaneous application of high-frequency ultrasonic fields delivered into wetted tissue, followed by traditional aspirates liposuction, to improve the mechanical removal of sweat glands. Ultrasound causes tissue destruction via three mechanisms: (1) cavitation, (2) micromechanical disruption, and (3) thermal damage.
Ultrasound reports suggest that the disruptive biologic effects of external ultrasound are due to a micromechanical outage or tissue heating. Other reports postulate that external UAL loosens adipose cell attachments, facilitating aspiration. The manifestations of the effects of external ultrasound appear to be directly proportional to the intensity delivered, with simple cellular detachment at 1 MHz to complete adipose cellular destruction at 2-3 MHz.
Recently, high-intensity focused ultrasound (HIFA) was used to treat and ablate subcutaneous fatty tissue before abdominoplasty cases with histologically proven success. This represents a new potential use for external ultrasound technology as a pretreatment regimen for ablating and remodeling subcutaneous deposits. All types of energy have been combined with liposuction to improve patient experience and results.
The “power” in power-assisted/power-tumescent liposuction uses a tiny mechanical tube (cannula) that efficiently removes fatty tissue. The mechanical vibrations produced by the power unit are soothing and may decrease procedure time. Powered liposuction can increase fat extraction by 30% over non-powered liposuction. Patients love the vibration sensation of powered liposuction or traditional non-powered liposuction.
Prof. Moawad was the first to use this technique in the Middle East 10 years ago. In power-assisted liposuction, a cannula with a back-and-forth motion of the tip passes through tissue to suction out fat and fibrous or scarred tissue with reduced effort. Studies that compared power-assisted to traditional liposuction found that power-assisted liposuction was superior in the ease and speed of fat extraction, faster healing and recovery time for patients, shorter procedure times with less surgeon fatigue, and lower incidence of the secondary touch-up procedure.
In a novel approach, Prof Moawad uses the above notice technologies to ensure gentle and complete removal of sweat glands. The patients were placed supine with their arms abducted by approximately 90%. A starch-iodine test is done, and photos of the results are taken. The hair-bearing area of bilateral axillae was marked and infiltrated with a 200 to 300mL of a tumescent solution consisting of 1,000mL of normal saline, 1mL of 1:1,000 epinephrine, 500mg of 2% lidocaine, 15mL of 8.4% sodium bicarbonate, and 1mL of 10 mg/mL triamcinolone using an infiltrating pump.
Two or three tiny stab incisions (2mm-3mm) were made at each axilla’s anterior and distal border, a special cannula attached to the power machine was inserted through them, and subcutaneous tunnels were made by it. By placing the cannula in subcutaneous tunnels with its three holes turned upward to face the sub-dermis, a back-and-forth vibrating movement is performed in a crisscross pattern and aided by the other hand to compress the skin for effective subdermal scraping.
The role of vacuum and vibration (mechanical) is to eliminate possible remaining sweat glands functionally and help achieve excellent results. At the end of suction and curettage, the skin pinched up quickly like a piece of cloth. The procedure in one axilla took about 15 to 20 minutes. The stab incisions are closed with Steri-Strips. Bulky compressive dressings are applied to bilateral axillae and kept for 24-48 hours. Afterward, the patient comes back to MSI to remove the bandage and wear his compression garment for the next two weeks. However, patients recovered their daily activities within 3–7 days.