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WHAT IS HYPERHIDROSIS

It is thought that about 0.5% of the population (or about one person in 200) has some form of hyperhidrosis. Despite 0.5% of population having hyperhidrosis, there are no nationally agreed guidelines.

There are two main types of hyperhidrosis. The more common type is focal hyperhidrosis which can affect the armpits, hands, feet or face. Generalised hyperhidrosis is less common, affecting the whole body and usually caused by another illness such as infection, diabetes or hyperthyroidism. When the illness is treated, the excessive sweating usually stops. Cause of focal hyperhidrosis

Sweating is controlled by emotions through the limbic system and the thermo-regulatory centre in the Hypothalamus. These affect the post-ganglionic sympathetic outflow of the para-spinal sympathetic chain. While the definitive cause of this condition is yet to be elucidated, most evidence points to a hyperactive autonomic system.

 

HOW IS HYPERHIDROSIS TREATED?

Initially, simple self-help measures may be useful:

  • Cool clothing
  • Avoiding certain foods which may trigger sweating
  • Reducing stress, tension or anxiety
  • Increased attention to personal hygiene

TREATMENTS

  1. Aluminium chloride is the active ingredient of some roll-on or aerosol anti-perspirants. It is used in stronger solutions to treat hyperhidrosis. The effects last only for 48 hours
     
  2. Iontophoresis is the passage of a weak electric current through a water bath. The area affected by sweating is immersed in the water and electrically charged particles clock the activity of sweat glands. When effective, this lasts for three-four days but can become longer with repeated use.
     
  3. There is a variety of drug treatment available. Some of these affect the body's entire nervous system and side effects such as a dry mouth, drowsiness and constipation can be troublesome. Where sweating is made worse by stress or anxiety, other drugs (beta blockers) may be used with less troublesome side effects.
     
  4. Injections of botulinum toxin (type A) into the skin has been shown to be a very effective treatment for axillary (armpit) hyperhidrosis. Effects start within the first week after treatment and last for an average of seven months before further injections are required. Side effects are rarely troublesome.
     
  5. Surgery can provide a permanent solution but the side effects can be serious. Surgery is usually considered when other methods of treatment have not worked.

PRIOR TO A HYPERHIDROSIS TREATMENT

Prior to your treatment you will have a thorough consultation with your aesthetic practitioner where all your questions are answered and you are assessed for your suitability to proceed.

THE TREATMENT

The treatment involves directly injecting the affected areas. This results in temporarily blocking the sweat glands and preventing perspiration. Because a very fine needle is used most patients find that there is only mild and temporary discomfort. The entire treatment usually takes no longer than 45 minutes. This treatment has been used on over 1 million patients worldwide for almost 20 years and is supported by a wealth of long-term safety data.

HOW LONG WILL A HYPERHIDROSIS TREATMENT LAST?

You will probably not need to have another treatment for at least 6 months, normally around 7-8 months. Following repeated treatments, the effects tend to last for a longer period of time. If you have a good initial result, please note that, as recommended by the manufacturers of the treatment, we aim not to perform any "top-up" treatments within a 3 month period following your treatment.

SIDE EFFECTS OF HYPERHIDROSIS TREATMENT

Side effects of Hyperhidrosis treatment are rare - indeed it is one of the safest cosmetic procedures available.

Side effects (fewer than 1% experience side effects):

  • Compensatory hyperhidrosis
  • Injection site pain
  • Hot flushes
  • Body odour
  • Pruritus
  • rash
  • Who shouldn't have hyperhidrosis treatment?

Studies have not been performed on women who are pregnant or breastfeeding. Although treatments are not thought to be dangerous, treatment is best avoided during this time. If you have any diseases, involving nerve damage or muscle weakness, Hyperhidrosis treatment is not recommended. It is also important to let your Doctor know if there is a family history of such diseases - for example Myasthenia Gravis or if you have previously suffered from Bell's Palsy.

Patients who are currently being treated with amino glycoside antibiotics or spectinomycin should wait until they have completed their course of treatment, and anyone who has had an allergic reaction to human albumin should not have Hyperhidrosis treatment.

PATIENT HISTORY

The patient will often give a history of focal, visible and excessive sweating that has come on without any apparent cause over the last 6 months. Often he/she has a family history of similar problems.

To be diagnosed as focal or primary axillary hyperhidrosis, at least 2 of the following characteristics have to be present in an otherwise healthy patient:

  • Bilateral and symmetrical involvement
  • Impairment in daily activities
  • Age of onset
  • Cessation of focal sweating during sleep

ASSESSMENT

  1. Ax of sweat stain:
    • Mild sweat stain 5-10cm still confined to armpit
    • Moderate 10-20cm still confined to armpit
    • Severe 20cm reaching the waistline
  2. Starch-Iodine test (Minor test):

2% iodine is applied to both armpits and allowed to dry; corn srarch powder is then brushed onto this area. The test is positive when the light brown colour turns dark purple as an iodine-starch complex forms in the presence of sweat. This is a pre-op record of affected area.

TREATMENTS

  1. Anti-perspirants containing 20% aluminium chloride hexahydrate, such as Anhydrol Forte or Driclor. They are roll-on gels or powder that bring about a reduction of eccrine sweat production by physical obstruction of the ductal openeings by the metal salts. They should be applied every nightafter carefully drying the skin for 5-7 days until max benefit is achieved and then frequency reduced to 1-2 per week. Wash off medication in the morning.
     
  2. Botox - Botox type A is a purified neurotoxin derived from clostridium botilinum. It works by blocking the release of acetylcholine at the neuromuscular endplates of the sympathetic cholinergic nerve fibres of the sweat glands.
     
  3. Iontophoresis involves an application of a direct electrical current across the skin. The mechanism of action of this modality is uncertain. While iontophoresis pads for axillary application are available, it is mainly used for palmar and plantar hyperhidrosis.
     
  4. Surgery of the sweat glands. This can include retrodermal curettage (scraping sweat glands away) or liposuction to remove the sweat glands from the undersurface of the axillary skin. However, these procedures carry a risk of infection and significant scarring.
     
  5. Anticholinergic drugs; propantheline bromide and glycopyrrolate work by blocking the acetylcholine secretion and can offer relief from the symptoms. However, the incidence of adverse symptoms e.g. visual blurring, dryness across mucosal surfaces and constipation reduce their utility when given systemically. Glycopyrrolate has been delivered topically using iontophoresis.
     
  6. Sympathectomy - the fourth thoracic ganglion of the sympathetic chain controls axillary hyperhidrosis - the part of the nervous system used to control the sweat glands in the axilla. This can be managed using an open or endoscopic approach to get relief from axillary hyperhidrosis. However, it is associated with a high incidence of compensatory hyperhidrosis from other areas of the trunk and is more suited to palmar hyperhidrosis.

BOTOX PROCEDURE

  1. After mapping the involved area by the minor test, an outline is drawn out with a white pencil.
  2. The enclosed area is then divided into a grid pattern with each of the grid squares being approximately 1-2cm. This is because of the dispersion of Botox being 1-2cm when placed intra-dermally.
  3. Botox is diluted 100U/4.0ml dilution of saline. 50U each armpit.
  4. Under anti-septic precautions, using a 30-gauge needle, 50U Botox is injected intradermally into each axilla (ensuring that a bleb is raised).
  5. Ensure that injections are spread out evenly over the grids marked out, starting from the periphery and moving to the centre, ensuring even coverage of the injections.
  6. Most patients have a perceived benefit within 1-2 weeks and have a duration of relief from 6-18 months.

CONTRA-INDICATIONS

  • Pregnancy/breast feeing
  • Allergy to any ingredient in formulation
  • Presence of rare neurological diseases such as Myasthenia gravis/Lambert eaton syndrome
  • Currently taking glycoside antibiotics

SIDE EFFECTS (FEWER THAN 1% EXPERIENCE SIDE EFFECTS):

  • Compensatory hyperhidrosis
  • Injection site pain
  • Hot flushes
  • Body odour
  • Pruritus rash

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