Excessive Sweating or Hyperhidrosis – Causes and Treatment – Auckland NZ

Hyperhidrosis is caused by overactivity of sweat glands in the skin. The glands exist in various concentrations throughout the skin. They maintain body temperature within a narrow range in the face of external heat or increase in physical activity. Sweat evaporates on the surface of the skin and transfers heat, primarily by direct conduction of heat from the vascular supply to the skin surface. Sweating can reach volumes measured in litres per hour. In hyperhidrosis (excessive sweating) although the glands themselves are normal, there is an abnormal neurologic response to stimuli in the hypothalamic sweat centres in the brain. Essentially, a sweating overreaction. The sweat glands are concentrated in the palms, soles, and under the armpits (axillae), and number around 2 to 4 million per person.

Anxiety or stress as well as heat or exercise stimulates sympathetic nerves to release acetylcholine. Acetylcholine is a neurotransmitter (nerve messenger) that then stimulates the muscle around the sweat glands to contract. Contraction of the sweat gland causes sweat to release. This is where Botox® works. It blocks the message from the Acetylcholine getting through to the muscle. No message received, no muscle contraction. No muscle contraction, no sweating!

There are two types of hyperhidrosis: primary hyperhidrosis, and secondary hyperhidrosis.

Primary hyperhidrosis is the most common type and is the one described above. It’s essentially an over-reaction type of sweating. There is no underlying medical condition and it often runs in families. Primary hyperhidrosis is more focal and tends to affect the hands (palmar hyperhidrosis), the feet (plantar hyperhidrosis) or the armpits (axillary hyperhidrosis).

Secondary hyperhidrosis is rare. It means hyperhidrosis that is due to an underlying cause (medical condition). This is more likely to cause generalised excessive sweating all over the body, rather than just isolated to e.g. the armpits, face, hands or feet.

Some underlying conditions that may cause secondary hyperhidrosis include:

• menopause hot flushes (often associated with excessive sweating at night)
• diabetes
• hyperthyroidism (overactive thyroid)
• some cancers (often associated with night sweats)
• myocardial infarction (heart attack)
• having an active infection

If your Palm Clinic doctor suspects secondary hyperhidrosis, they will refer you to the appropriate healthcare provider for investigation.

It’s also important to remember that some level of sweating is a normal response to an emotional stress/heat stimulus. If one’s only concern is excessive sweating during exercise and they have no trouble outside of when they exercise, then unless it bothers them, they may not need treatment.

Botox® (botulinum toxin) is a natural, purified protein, which works by preventing the release of acetylcholine in sympathetic nerve endings associated with the sweat glands. In other words, Botox® injections stop the muscle surrounding the sweat gland from squeezing out the sweat and is an effective treatment option for those suffering from hyperhidrosis. There are very few potential side effects.

Palm Clinic in Auckland, New Zealand has a team of expert doctors who specialise in Botox® treatment for excessive sweating. The treatment costs a total of $1,600 for both armpits.

Axillary hyperhidrosis is excessive sweating of the underarms and is a common problem for men and women. Hyperhidrosis (excessive sweating) is a condition where your body produces more perspiration than is needed to cool the body and maintain appropriate body temperature. This means excessive sweating even in cool temperatures and without physical exertion. Stress can aggravate the condition, but the excessive sweat can occur with or without stress.

Excessive underarm sweating is a problem that can lead to extreme anxiety and self-consciousness. Bromhidrosis or osmidrosis are related problems in which underarm odour, with or without excessive sweating, is the main problem. Many treatments have been trialled for hyperhidrosis with varying degrees of success. The latest non-surgical technique is Botox® treatment.

Hyperhidrosis Botox® works by relaxing the muscles around the eccrine sweat glands so that the perspiration is not squeezed out onto the skin. This works extremely well for around 3-12 months and can be life-changing for those with a significant problem.

Have you worried about sweaty palms when you need to shake hands?

For some people this can affect confidence and self esteem and lead to difficulties in the workplace. The problem can be treated with botulinum toxin which switches off the excessive sweating for on average of 3-12 months.

Treatments involve injecting between 50-100 units of Botox® into each palm (and fingers) depending on how bad the problem is. Most people start with 50 units per palm at a cost of $1,600 in total, with 100 units per palm costing $2,100.

Sweaty feet can be an extremely embarrassing condition which can be improved with Botox® injections. While Botox® works particularly well for sweaty armpits and sweaty palms, the results for sweaty feet can be less predictable because of the thickness of the skin in this area.

Typically, you would need at least 100 units of Botox® per foot at a total cost of $2,100 for both feet. Some people need even more than this and the duration of efficacy is very variable. For these reasons we only recommend treatment of sweaty feet for particularly severe cases in those people who are very distressed by the condition and are prepared to accept that despite the high costs the results are variable.

• Botox® (botulinum toxin). Botox® is FDA approved (Food and Drug Administration in USA) for the treatment of axillary (armpit) hyperhidrosis. Botox® is administered through a very fine needle into the affected skin. Sweating diminishes substantially within 48 hours and results can last from 6-12 months in the armpits. Botox® is quick, simple, effective, and relatively painless. Treatments cost $1,600 to treat both underarms (50 units each side) and $1,600-$2,100 for the palms depending on whether we use 50 or 100 units per palm. Treatment takes around 20 minutes with a follow-up two weeks later if necessary.
• Traditional Treatment for Excessive Sweating. Traditional dermatology therapies have included aluminium salts used in cosmetic antiperspirants, iontophoresis or drugs such as glycopyrrolate. Human sweat is largely odourless but bacteria on the skin thrives on the skin with the sweat to create odour. Deodorants work by temporarily killing bacteria and masking the odour with a fragrance whereas antiperspirants work by plugging the sweat gland usually with compounds containing aluminium chloride. Topical therapy has been limited in success and often causes skin irritation. Oral medications can have unpleasant side effects such as blurred vision,dry mouth and urinary retention and have limited effectiveness on sweating.
• Hyperhidrosis surgery: Endoscopic thoracic sympathectomy is a surgical procedure which involves cutting the sympathetic nerves that supply the sweat glands. This is performed through keyhole surgery and usually takes a few days to recover from. Compensatory sweating from other parts of the body after treatment can be a problem. Sympathectomy has a recognised complication rate including Horner’s syndrome, pneumothorax (collapsed lung) and injury to nerves.
• Direct excision of affected skin creates unwanted and unsightly scarring often with prolonged recovery and limitation of mobility, and so, is a less desirable treatment option.

Given the alternatives above, Botox® has proven to be a safer and more effective treatment option for hyperhidrosis.