In hot and sunny Singapore, it is normal to sweat, right?
Yes, it is usually normal. Indeed, sweating is one of the most important ways that your body dissipates heat and regulate the body’s temperature. However, for a small minority of people, their body produces sweat in amounts far greater than what is needed for normal thermoregulation.
In most cases, this excessive sweating is often produced on relatively minor triggers like certain types of food or in social situations involving minor anxiety or strong emotions; In some people, the sweating reflex is even triggered inappropriately e.g. When feeling cold.
Medically this excessive sweating is termed as hyperhidrosis. Studies show that as many as 2-3% of the population suffer from this problem. Hyperhidrosis leaves patients constantly feeling wet or damp in certain parts of the body. Nowhere is this more embarrassing than having the telltale sweat marks on the clothing in the armpit area; Not to mention the possible odour that it causes.
To be sure, the sweat itself doesn’t produce the odour, but if the sweat remains in the armpits for a sufficient amount of time, bacteria eventually starts to work on the sweat and this produces the smell that we are all too familiar.
Most combat this problem using anti-perspirants, which have a long history, being invented more than a century ago. The active ingredient in such products are actually aluminum salts and now comes in many forms like aerosol sprays, creams, roll-ons and even crystals.
These work by interacting with the electrolytes in sweat to form a gel-like plug in the ducts of the sweat gland to prevent the sweat from reaching the surface of the skin. This is actually quite an elegant solution to the problem but this plug may not last long and gets sloughed off easily. In addition, its efficacy varies from person to person, working well for some people while being close to ineffective in others.
In particular, for people with hyperhindrosis or excessive sweating, anti-perspirants are only effective if used in high concentrations and in these concentrations, local skin irritation is common.
Nevertheless, anti-perspirants are easily available over-the-counter and is currently the most popular treatment for hyperhindrosis.
For patients whose sweating problems are more severe than what anti-perspirants can treat, or desire a more complete and lasting treatment, they can undergo a surgical procedure called endoscopic thoracic sympathectomy (ETS). This involves clamping or destroying the part of the nerve that controls sweating in the affected areas.
Being a surgical procedure, this involves some downtime for patients and some side effects are often reported. These side effects can range from trivial to some relatively debilitating. Oftentimes, there is compensatory sweating in areas that have not been treated, causing more sweating that what is usually experienced in other parts of the body.
Additionally, due to nerve regeneration, the procedure may not ensure a complete and permanent relief, with some patients reporting a recurrence of the sweating problem as early as 6 months post procedure.
For patients who are not keen for surgery, this is where BOTOX comes in.
As most are aware, BOTOX is the protein derived from toxin produced by certain bacteria which paralyses muscles, including those of the face to remove wrinkles.
What is less known however, is that this same protein is also useful in disabling sweat glands. This new indication for the use of BOTOX has been approved by the United States Food and Drug Administration just over 5 years ago.
This procedure involves first using a dye to highlight the areas that are producing excessive sweat in the armpits. Then, using a very fine needle, a series of injections are made in the offending areas. As the needle is very fine and only a small amount of fluid injected each time, pain is usually not an issue. There is also no downtime and normal activities can be resumed almost immediately post procedure.
The BOTOX works by interrupting the actions of the nerves that supply the sweat glands and hence, preventing the glands from producing sweat.
The sweating stops in more than 90% of patients less than a week after treatment with many reporting good results as early as a few days post injection. In rare cases, a top up may be needed to augment the effects if results are not satisfactory after the first procedure. Side effects from the procedure are usually minor, e.g. Mild swelling and erythema at the injection site. As the injections are very superficial, it does not affect the underly tissues like nerves and blood vessels. Moreover, the treatment is local, so there are no widespread side effects on the body.
For long suffering patients, this therapy is a delightful change, liberating them from the daily worries of sweating in the wrong place at the wrong time. Along with it, odour problems become a thing of the past.
Nevertheless, BOTOX is not a permanent cure for hyperhindrosis and the effects last anywhere from half a year to almost year (depending on individual patients) before starting to wear off slowly. When this happens, don’t worry, the treatment can be repeated… No sweat!
About Dr Ong
Dr Ong obtained his Bachelor of Medicine and Surgery from the National University of Singapore (now called Yong Loo Lin School of Medicine) in 2004.