Advanced management of excessive sweating

Excessive sweating is of two types. The excessive sweating that is confined to localized and specific areas, like armpit, palms and soles goes by the name axillary hyperhidrosis and the latter palmoplantar hyperhidrosis. This type of excessive sweating is not caused by any medical condition and has no causal relationship. These patients do not sweat in sleep. This type is called Primary hyperhidrosis or Focal hyperhidrosis. The initial approach in the treatment is to provide medicines to physically block the sweat gland ducts so that the perspiration does not come out. In quite of lot of the cases, they may not provide the relief that the patient requires. These stubborn cases need more advanced techniques and in very obstinate ones surgical severance of the sympathetic nerve or removal of the sweat glands themselves. These are, however, not without consequences.

– Iontophoresis. A small device introduces a low direct current into the tap water which is circulated over the skin. This treatment has been in use for about 50 years or so. The exact mechanism of how it works is not clear. A session of 10 to 20 minutes is carried out 2 to 3 times in a week. Depending on the patient’s response it is repeated in one to three weeks’ time. This treatment is painless.

– Botox, a nerve toxin which can temporarily paralyze muscles, came into medical use in cosmetic surgery for removal of wrinkles. 20 to 25 spots are selected under the arm and a small amount of the toxin is injected with a fine needle. The injection is very painful and a using a fine needle makes it tolerable. It is found to give relief for up to 12 to 14 months. Since the FDA has cleared Botox only for underarm hyperhidrosis, it is not used for palmoplantar hyperhidrosis.

– Microwave and laser energies are also used to destroy the sweat glands. Microwave therapy is a one-hour long process where the patient is given local anesthesia and the skin is cooled during the surgery. It is repeated two or three times in a week for better results. With laser, it can be done faster and without discomfort.

– Thoracic sympathectomy is a surgical procedure wherein an endoscopic instrument is introduced between two ribs below the underarm and the sympathetic nerve is severed. When it is severed, it ceases to give the signal to the glands and they stop their work. These treatments have side effects. It has been found that the sweating elsewhere in the body increases.