Written by Jennifer O'Neill, Consultant Plastic Surgeon at The McIndoe Centre
Summer is finally here - the season of holidays, barbecues, parties and weddings, all fantastic occasions where you want to look and feel your best.
Unfortunately for those who suffer with Hyperhidrosis (excessive sweating) under the arms it can also be stressful and embarrassing trying to manage the condition with its unpleasant odour and wetness. Although anti-perspirant deodorant can go some way to solving this problem, more and more patients are looking for a more effective solution.
What is Hyperhidrosis?
The prevalence of excessive sweating with no known underlying cause is reported to be between 3% and 5%, with the most common area reported being the underarm area with a prevalence of over 1% of us having an issue in this area.
Excessive underarm sweating can be a major problem and may impact on quality of life. A Hyperhidrosis severity scale has been developed to assess the degree to which underarm sweating bothers patients and it can gauge if the condition is tolerable or not and if it interferes with daily activities. It is important for patients to see their GP to exclude any medical causes for excessive sweating such as an overactive thyroid or diabetes.
Treatment of the condition
Patients with excessive underarm sweating are advised to avoid any triggers – where possible – such as heat and anxiety.
The first line of treatment is usually topical therapy which is applied overnight. Aluminium chloride is used to block the sweat ducts and can be useful for some, but can also cause irritation or dermatitis. Patients often have concerns about Aluminum being linked to Alzheimer’s and/ or breast cancer although the evidence for this is not proven. Other treatments gaining popularity include microwave therapy and iontophoresis (electric current therapy).
Medications can be used but may have other side effects (for example dry mouth, blurred vision and bladder problems). Surgery may also be advised to divide the nerves that cause the sweating but this can have surgical complications and also sometimes result in compensatory sweating elsewhere.
As an alternative treatment I am able to offer, after an initial consultation, botulinum toxin injections. Axillary Botox for excessive sweating of the armpits has been in use since 1996 with good results. The toxin acts to block the transmitter signal being released from nerves that usually stimulates the sweat glands. With less signal the sweat glands reduce the production of sweat.
It is safe and effective with a low risk of any side effects - the use of Botulinum toxin type A for the treatment of axillary hyperhidrosis was approved in 2004 by the US food and drug administration (FDA).
Patients report that after a week or so they notice excellent results and relief from their excessive sweating and also a reduction in odour symptoms.
What does the procedure involve?
To locate the areas of maximal sweat production an iodine starch test can be performed. This is not always necessary but may be useful if it reveals an area of sweating that does not correspond to the hair-bearing area. A grid is then drawn on each armpit and multiple injections with a small needle are spaced out to deliver the treatment. It is surprisingly well tolerated and patients usually report that it is easily bearable.
It is not necessary to shave for the procedure and, for those who do shave, a couple of days without shaving before the procedure is advised. I ask patients not to use any products under the arms on the day of the treatment either before or after the procedure. It is best to avoid active motion and exercise for 24 hours after the treatment.
You will not be able to have Botulinum injections if you are pregnant or might be pregnant, breast feeding or have any nerve or muscular problems. It may not be possible to have the treatment if you are taking certain antibiotics or muscle relaxants. If you have any bleeding disorder or are taking anticoagulant drugs you need to inform the doctor.
There are usually no untoward side effects but the injections can cause soreness and swelling. Sweating may be a problem in other areas. Muscle weakness and joint stiffness have been reported but are unlikely.
How long does it last?
The benefit of Axillary Botox lasts approximately 6 to 9 months. This is longer than the effects of cosmetic Botox used on the face to prevent facial lines and wrinkles.
Consultant Plastic Surgeon
Jennifer O’Neill is a fully qualified plastic, reconstructive and aesthetic surgeon and treats patients within a specialist clinical setting at The McIndoe Centre. She is on the GMC specialist register for plastic surgery and is a member of the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS).