Treatment of excessive sweating / hyperhidrosis
Sweating is a natural function which, when excessive, may cause significant discomfort
Sudoresis (or sweating) allows heat to be removed by evaporation of water from the skin’s surface. Sweat is produced by two types of glands: eccrine glands located throughout the body (largely in the palms and soles) and apocrine glands located in the armpits, genital area, the external auditory canal and eyelids.
Hyperhidrosis is the production of abnormally high amounts of sweat. Rarely spread throughout the body (alcoholism, chronic infections, metabolic diseases ...), it is most often localised (underarms, palms, soles of the feet).
Localised hyperhidrosisaffects 6-7% of the population and appears in young adulthood. The exact origin is unknown, but a family history has been found in nearly 1 out of 2 cases, suggesting a genetic factor. It is often aggravated by stress, emotions, spices, tea and coffee.
People with localised hyperhidrosis are sometimes reluctant talk about it or are not aware of treatment options. The consequences are quite serious :
- in the hands, decreased dexterity in performing manual tasks or during some sporting activities, embarrassing sweaty hands when shaking hands or a hindrance for certain professions (hairdressers, bakers ...) ;
- in the feet, moisture encourages the development of certain diseases (fungal, Dyshidrotic eczema, warts, corns, chilblains ...) ;
- in the armpits, yellow sweat stains are embarrassing both professionally and socially (employees who work with the public) reflecting an image of lack of confidence or anxiety. In addition, the sweat ruins and stains clothing.
Finally, excessive sweating is odorous (which is a bacterial breakdown of sweat and not the sweat itself).
How to reduce sweating ?
- Combat stress : The anxiolytic treatments such as hydroxyzine or psychotherapy can help manage stress and should not be overlooked ;
- Antiperspirants : Modern antiperspirants are made with perfume to mask odours and antiperspirants are slightly toxic and irritating (containing aluminum salts, bromine salts and zirconium ...). Talc and alum (choose one alum stone = 100% natural without aluminum salts!) are effective and non-irritating but are difficult to find in stores, whereas modern antiperspirants are commonly available.
- Iontophoresis : It is more suitable for the treatment of excessive sweating in the soles and palms. They are dipped in a bath with a direct electric current. This electrical current causes a partial obstruction of the sweat glands. Each session lasts about 20 minutes and several sessions are required (about ten for the first 2 months and then one every month). The effect is moderate and reversible.
- Botulinum toxin injections : It is the most effective treatment. Safe injections of botulinum toxin (Botox®) induce a decrease in sweat production by blocking the cholinergic nerve fibers. This highly effective procedure is temporary. The sessions must be repeated every 5-6 months to extend the benefit of treatment or before the warmer seasons. With armpits the injections take place at Dr. Laveaux’s office 2 hours after the the application of a numbing cream. With soles and palms, since the injections are too painful to endure with just a numbing ointment, Dr. Laveaux administers them at the Polyclinic Saint-Jean under analgesia.
- Excision-curettage of axillary sweat glands : curettage of axillary glands is an alternative to Botox® injections in the treatment of axillary hyperhidrosis. Performed under local anesthesia, the procedure involves surgically removing a portion of the axillary glands by "scraping" the deep surface of the dermis. This leads to a permanent reduction of 40 to 60% of the production of sweat in the armpits, which is generally very satisfactory for the patient. The procedure lasts 30 minutes. The scar is 10 to 15 mm in length which islocated in the natural crease in the armpit, making it invisible. A permanent reduction in the axillary hair is sometimes the result of the procedure. Just like Botulinum toxin injections, this procedure is not covered by health insurance. The liposuction technique leaves a smaller scar but this method is less effective.
Author: Dr. Christophe Laveaux
Specialist in aesthetic surgery - Antibes
Reproductions, even partial, of the texts are allowed on the express condition cite the author (Dr. Christophe Laveaux) with a direct link to the article mentioned.