Excessive sweating

Axillary hyperhidrosis describes excessive underarm sweating. It is a relatively common problem affecting around 3% of the population. It often comes on as a teenager but may occur from childhood or later in life. It may improve later in life but tends to cause severe psychological distress in teenagers and young adults. Typically sufferers describe being severely limited in what clothes they can wear and have to replace clothing very frequently.

Palmar/plantar hyperhidrosis describes excessive sweating of the palms or soles of the feet. It too can cause significant distress to sufferers and affects social interactions, such as shaking hands; footwear choices due to slippery feet and ability to complete certain tasks such as writing and fine motor work.

Hyperhidrosis usually starts in childhood or adolescence but some people first experience it as adults. The impact of this condition is often underestimated it can affect work and social situations and may cause significant psychological distress. Fortunately, effective treatments are readily available.

It is thought to be a genetic condition with about 1/3 of sufferers having other members of the family affected.

It is most commonly due to an excess of apocrine sweating, which is the type of sweat produced with anxiety or stress. These sweat glands are predominantly located under the arms and on the palms and soles. This sweat is different to the eccrine sweat that is produced over the head, trunk and limbs and functions to help regulate body temperature and cool down. For this reason, treatments used for hyperhidrosis to not interfere with body temperature or other sweat functions.

Physical and emotional stress are the most common triggers for the excess sweat production but some sufferers will produce sweat constantly. In most cases of hyperhidrosis, excessive sweating does not accurately during sleep.

In most cases of hyperhidrosis, no special tests or investigations are required.

Uncommonly, excess sweating is related to an underlying medical cause (secondary hyperhidrosis) such as a thyroid disorder or other hormonal irregularity. In these cases, the sweating is usually accompanied by other symptoms or signs which could include: fevers, weight loss, nighttime sweating, joint or muscle pains or headaches. In this situation, further investigation may be required to exclude associated problems.

Topical therapy:
Mild cases can respond to topical treatments such as aluminium chloride hexahydrate (Driclor) which is available over the counter at a chemist. Driclor needs to be applied to clean dry skin and given time to absorb before sweating occurs. For this reason, is best applied after a shower at night and dried off with a hairdryer on cool settings if needed. Driclor with react with water (and sweat) to form an acidic irritating chemical so it’s use may be limited by severe skin irritation. Compounded glycopyrrolate (0.5-3%) cream can also be effective. A prescription is needed and the cream is generally well tolerated although may not be effective in more severe cases.

Botulinum toxin type A (Botox®) injections:
Botox® injections are approved for treating axillary hyperhidrosis in people who have not improved or not tolerated Driclor. Fortunately, it is safe and very effective. Treatment is performed via a series of small injections under the arms directly into the sweating region. The effect is generally seen in 2-4 days and lasts 4-9 months (average 5-6). Side effects other than injection site pain are rare.

Under Medicare and PBS guidelines, up to 3 treatments are subsidised per year with a minimum of 4 months between treatments, provided patients meet eligibility criteria. At Complete Skin Specialists, patients will have a gap of approximately $400 after Medicare and PBS rebates. A referral from your GP is required but a booking for treatment with one of our dermatologists can be made directly without booking a consultation prior. Please contact our Cosmetic and Laser clinic to book directly.

Iontophoresis
Iontophoresis utilises the passage of an electric current through the sweat glands to temporarily shut down the sweat gland activity. It is typically used for excessive sweating of the hands and feet may be considered for cases which do not respond to topical treatments. Treatments are individualised. The affected area is immersed in tap water, salt water or glycopyrrolate solution. Then a gentle electric current is passed across the skin surface for 10 to 20 minutes. Treatment tends to be slightly uncomfortable due to electric current and can be very time consuming due to the ongoing need for treatment. Home units can be purchased making this more realistic.

Oral medication
Anticholinergic tablets (such as oxybutynin and propantheline bromide) can be effective in some patients but side effects such as blurred vision, constipation, dry mouth and excessive drowsiness commonly limit treatment.

Endoscopic thoracic surgery
Endoscopic thoracic sympathectomy (ETS) is a surgical treatment performed by a vascular or neurosurgeon under general anaesthesia. The main risk is a significant chance of compensatory hyperhidrosis (new excessive sweating elsewhere on the body), which occurs in 25-50% of cases. For this reason, surgery is rarely considered for areas where other treatment options with better results and safety profile are available.