Hyperhidrosis, a condition affecting thousands of Australians, is defined as excessive sweating, primarily affecting the axillae (armpits) and extremities (hands and feet). It can be an embarrassing problem, impacting self-esteem, clothing choices and social activities. Regular deodorant doesn’t offer any relief, with people resorting to absorptive pads to soak up excess sweat and choosing dark clothes to hide sweat marks.
Our Hyperhidrosis Treatment Program can help set you free from your sweaty prison.
Our Hyperhidrosis Treatment Program includes a tailored combination of treatments:
- Medical grade topical deodorants, such as Driclor, glycopyrrolate topical preparations
- Anticholinergic oral medications
- Injectable botulinum toxin muscle relaxants, normally used to treat facial lines and wrinkles
- Hyperhidrosis surgery, known as sympathectomy
- Minimally invasive sweat gland liposuction can be performed in appropriate cases by Dr Rich
- Iontophoresis for palms and soles (a medical device that passes an electrical current through skin)
Medical-grade topical deodorants and anticholinergic medications often cause unacceptable side effects, while hyperhidrosis surgery is very invasive. Injectable muscle relaxants however, tend to well tolerated and act by reducing the stimulation of the sweat glands.
At ENRICH, hyperhidrosis treatment with injectable muscle relaxants are performed only by our skilled doctors. It is important to be aware that it may take 2-3 weeks following the injection process for the full benefit.
Contact us to arrange a medical assessment of your hyperhidrosis and treatment plan with Dr Michael Rich.
How we use botulinum toxin for excessive sweating treatments
Hyperhidrosis is the fancy name we have for being a bit too sweaty for our liking, or if you like, excessive sweating. The way our sweat glands are turned on or off is via nerve signals, so when we treat hyperhidrosis with botulinum toxin, what we are really doing is stopping the ‘start sweating!’ nerve signal from reaching its target: the sweat gland. Blocking the nerve is a very effective – albeit temporary – method of reducing sweat production. It works very well, but all excessive sweating treatments are imperfect.
Botulinum toxin hyperhidrosis treatments last for many months, but it eventually gets reabsorbed into your body and the effect disappears, usually six-monthly. This hyperhidrosis treatment may be suggested when other treatments have not produced results since the process itself can be quite uncomfortable, particularly when we’re talking about the palms of your hands and the soles of your feet.
We can target your underarm sweat glands and groin sweat glands with a series of injections for temporary relief from excess sweating. Botulinum toxin for sweating usually only works well on small areas because we can’t relax too many muscles or nerves, or it could disrupt other functions of your skin and body, which we don’t want.
How do sweat glands work?
You have two types of sweat glands – eccrine sweat glands and apocrine sweat glands – with both a tiny tubular structure in the skin known as an exocrine gland – it squirts stuff out onto your skin as opposed to into the blood (which endocrine glands do).
Eccrine sweat glands
Eccrine sweat glands are controlled by the sympathetic nervous system and regulate your body temperature. You get hot, and the eccrine glands get mostly water onto the skin’s surface so that evaporation provides cooling.
If you remember science class, and that energy never disappears but only changes form, then you can understand how evaporation works to cool you – heat is transferred from your body into the water, which then passes into the air – out of your body. Additionally, our skin feels cooler when the breeze hits moist skin if the air outside of your body is not already quite water-laden (humid). A fan causes the water on our skin to evaporate faster, taking the heat with it – cool, huh!
Only mammals have eccrine glands, but not all animals have them all over our bodies like humans. In fact, only a few do – for example, horses and bears – while some other animals like cows, donkeys, dogs, cats and sheep only have sweat glands in their paws or lips. This is why dogs pant to cool down – same process, but using moisture in the breath. Smaller animals are not able to lose that much water so do not sweat at all.
Apocrine sweat glands
Your apocrine sweat glands are associated (generally) with hair follicles, and continuously secrete sweat that contains fatty molecules into the glands. These glands are mostly concentrated around the groin, anal area and armpits, and are not used for cooling, but as a type of chemical messenger. Ever heard about ‘the smell of fear’? It’s a real thing, and your apocrine glands are responsible.
These glands work all the time, but they really ramp up their action when you feel stressed emotionally. The tubule wall contracts, expelling this fatty sweat onto the skin. Bacteria break this sweat down into smaller, odour-laden fatty acids. These specific glands are not active in children; only after puberty does the ‘on’ signal for apocrine glands appear, indicating their usefulness in our adults lives, unbeknownst to us. (Our sense of smell goes way beyond what we think we can smell – our noses are molecule detectives.)
How many sweat glands do we have?
The main ways in which we recontour the body are liposuction in major and minor areas, breast adjustments, face and neck sculpting, and cellulite treatments.
When you come in for your consultation, your doctor will thoroughly examine you and discuss your wishes with you to get a good overview of what it is you are after.
Who gets the best results from hyperhidrosis treatments?
The number of sweat glands in each of us varies hugely, but the areas in which sweat glands are placed are always the same. Sweat glands may exist, but not be active.
The palms are estimated to have about 370 sweat glands per square centimetre, so the average hand could possibly have thousands and thousands of sweat glands on the palm alone. The back of the hand by contrast has about 200 per cm2 , the forehead about 175 per cm2 , the breast, belly and forearm, about 155 per cm2 . The back of the legs, however, are thought to only have between 60 and 80 sweat glands per cm2 .
On your finger pads, the sweat glands are irregularly set, and because the skin on the feet and hands is so thick, the way sweat glands are interlaced into the epidermis is somewhat different to the rest of the body. This is why our hands and feet feel different than other parts of our body when we sweat.
Things that make us sweat – hyperhidrosis triggers
There are a few things that cause human beings to get sweaty.
- Being hot (thermal triggers; thermoregulation) – controlled by the hypothalamus
- Getting emotional (emotional triggers – fear; anxiety; pain; stress)
- Food (chilli, capsaicin – binds to heat receptors in the mouth; heated food; increased metabolism caused by digestion)
*Results may vary from person to person
Hyperhidrosis surgery – a sympathectomy
Hyperhidrosis surgery consists of making a cut to the sympathetic nerve – the nerve that controls sweating. This surgery has been performed for over two decades with good results. The nerve is cut in specific places, though previous surgeries used to remove this nerve completely – we don’t do that anymore.
Those who have very sweaty palms and underarms tend to respond best to hyperhidrosis surgery, though success has also been seen in those with excessive sweating of the face and scalp. Those with sweaty feet don’t respond typically quite as well to hyperhidrosis surgery.
The cut is made between the ribs with microscopic precision.
Can hyperhidrosis be caused by an illness?
Yes, hyperhidrosis can be caused by a few different medical conditions. You will need to be evaluated for these conditions prior to any hyperhidrosis treatment.
- Fox-Fordyce disease–apocrine sweat gland inflammation resulting in dry, itchy rash on the underarms and groin
- Frey’s syndrome–nerve damage often due to removal of a salivary gland, causing sweat to be produced in the cheek below the ear when you would normally salivate
- Heatstroke –once your eccrine glands are exhausted and unable to produce more sweat, you get heatstroke, which can lead to you overheating, possibly causing death
- General hyperhidrosis–pathological, excessive sweating, usually triggered by stress or heat, but may appear without stimulus, unknown pathology (possibly trench foot, encephalitis, nerve inflammation or damage)
- Milaria rubra–‘prickly heat’, sweat gland rupture inside the skin
- Osmidrosis–(or bromhidrosis), excessive odour from apocrine sweat glands
- Sweat gland tumours
- Another disease that causes sweat gland dysfunction
What happens during hyperhidrosis treatment with botulinum toxin?
How your procedure goes depends where you are being treated on your body. The armpit usually requires a few injections with a very fine needle, normally without anaesthetic because it’s not painful. It can be uncomfortable, but it’s over quite quickly. Numbness may linger for a few hours, but it should resolve.
Results from injectable hyperhidrosis treatment – Melbourne
The results usually take a week or so to appear. You’ll need to avoid any massage treatments around the injection area, vigorous exercise or any pressure – the action can dissipate the injection fluid and make it less effective.
Recovery from injectable hyperhidrosis treatments – Melbourne
You may see a small bruise appear at the injection site, which will disappear over a few days. Some people get flu-like symptoms as a side effect, or even more rarely, you may sweat in a different area of your body as a sort of compensatory act of your body. Side-effects are very uncommon, but your doctor will go through everything with you in detail prior to the treatment.
You cannot get botulinum toxin injections if you are pregnant or breastfeeding, or if you have some specific medical conditions.
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