Hyperhindrosis-No Sweat!
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.
26 Comments
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Our Chief Medical Officer
My face always sweat,I ever seen dr, the dr gave me driclor apply,only can last 1 week and start sweat after 1week. .very painfull when I apply driclor on my face. ..
Hi cindy,
You can consider using Botox injections to control the sweating. Although the injections are also uncomfortable, at least it lasts for a few months.
rgds
Dr Tan
I’ve the exact same problem as cindy. I often sweat excessively on the face and neck area. It’s unsightly!
Dr Tan: How ‘uncomfortable’ is the Botox injection? And what’s the price range like? Are there no other permanent solutions?
Hi Jo,
I wish there was a permanent solution. If you come across something please share! Women usually take Botox injections very well. I have never come across a lady who complained Botox was painful. I must warn you that using Botox for the face and neck to reduce sweating is a little tricky. Because it might also affect the muscles underneath, we have to be careful with where we place the injections. So results may not be as dramatic as the same treatment for the armpits. Price range depends on how many units we need to use. A rough guide would be $300 for the face and $300 for the neck.
rgds
Dr Tan
Dear Dr Tan
Can you believe my whole body NEVER sweat ? Only my face,neck sweat. If i exceedingly sweat on my face after running or in hot weather my face and neck will become Very Red and i felt very dizzy..See many skin speacialist Dr ,then he told me No medicine can stop sweat and he cannot believe my body never sweat. Have you come across patient like me?
Hi miao,
That is strange. Sweat glands are found all over the body. It is more likely you sweat much more on your face and neck and not realize the small amount of sweat from your body. Doesn’t your T-shirt become wet after a run?
rgds
Dr Tan
Dear Dr Tan
我就说您一定不相信。如果我说从我出生到现在一来没湿过您会相信吗？我赛跑也希望背后会湿，我每次很羡慕那些背后会流汗的人。等有一天我去星加破用走路或跑路去clinic找您您看了一定相信我，我的汗一出十再难停需要用冷气吹。有好医吗？我是不是怪胎？^o^
Dear Dr Tan
您说可以用boTok injection,那是不是三四个月没有流汗？用过Driclor,真的没有地方流汗，感觉很爽很凉，但是只耐一星期。有办法弄我背后流汗吗？不是我没realize，是真的一滴汗都不曾出，我每次有用手摸的。真的没有一个医生相信我说。失望:(
Hi Dr Tan,
I’ve a problem which I’m not sure if it’s a medical condition. I have been doing street dance (attending dance classes) for about 6 years but since about 1 yr ago, I realised that I tend to perspire alot more than what I used to. Each time after I attended a class, my whole body would be drenched in sweat and I looked like I just bathe…. I understand that it is normal to sweat due to exercise but I think I’m sweating abit too much. How???
Hi Fion,
Street dance just sounds so cool. There is really no such thing as sweating too much. From a physiological point of view, sweating is a very effective method of cooling the body. Our body automatically wants to maintain homeostasis (i.e. eveything stays the same), so as core body temperature rises, the body sweats to cool itself (loss of latent heat when sweat evaporates). Most people feel very good after a sweat and thinks it has cleansing properties. Either way, sweating when working out is actually a good thing. You really should not be concerned. At least not from a medical point of view.
rgds
Dr Tan
Hi Dr Tan,
Thanks for the prompt reply! Appreciate much! Well, i do understand that it’s normal to sweat but it’s just that I hate it when my hair gets wet cus of my sweat and i’m unable to ‘whip’ my hair when i’m dancing. And I can’t really wear light colored bottoms to dance cus I’ll sweat so much that the sweat will ‘stain’ the bottoms and make me look like I wet my pants…. Quite disturbing =(
Hi Dr Tan. Would like to check with you about botox for excessive sweating. After the injection say after 1 week can we resume doing exercise. And will i continue to sweat at the injected area when doing exercise or in a warm weather. If yes still sweating would it be excessive or reduced?
Hi Asmi,
You can resume exercise 24 hours after the injection. Botox will reduce but not eliminate sweating. You will still sweat a little from the injected areas. Obviously the non-injected areas will continue to sweat.
Rgds
Dr Tan
Thank you Dr Tan.
Hi Asmi,
You are welcome.
rgds
Dr Tan
Hi Dr Tan
运动把身体里面的脂肪燃烧了,让自己瘦下来会不会减少流汗?
Thanks.
Hi dr tan,
Im 20 this year and I’ve had genetic body odour from my armpits since young. It has always been a social problem to me and have affected me psychological when I was younger. 6 years old, I discovered perspireX and have been using it ever since. It did a great job in keeping the odour in discretion. However, once I stop using it, the odour comes back. I understand sweat itself have no smell at all. It’s the bacteria presence on my armpit skin that’s causing the problem. Other than the armpit area, I have no sweaty palms or other areas. because I’ve relied too much on the deodorant, it made my skin really sensitive and itchy. I really want to stop using the product and seek for a permanent cure. However, ard 5 years back, I went to see a dermatologist and he said that the surgical procedure is more suitable for people with sweaty palms and that there’s no procedure for armpits only at the point of time. I understand that there’s a lipo surgery overseas to deal with my problem, but it’s not available at all in sg. what I asked the doc was 5 years old ago.. Is it still the same for now? Can I undergo ets jus for
My armpits only? I really wna get over this. Thanks in advance
Hi Mandy,
You have obviously been doing your research and I agree with everything you have said. There is really no permanent way of stopping sweat production in the armpits. You can try to control the bacterial load first with antibacterial soaps and antibacterial powders. Doing permanent hair removal can also help reduce the bacterial load. Then there is Botox to control the sweating. This is also temporary and not a permanent cure. I suggest you try this first – wash your armpits daily with Chlorhexidine soap (availble at any pharmacy) and use Ammens medicated powder. After a week, the odour should be gone. Hopefully.
rgds
Dr Tan
Hi Dr. Tan,
Im 38 years old and currently suffering from sweaty palms, feet and armpits. I’ve noticed a severe sweating after I gave birth to my daughter. Hence, it’s giving me a hard time taking care of my baby. I cannot hold her for long because my palms will start to sweat. I always wear dark color and bring jacket to hide wet patches in my clothes. I cannot queue to register my fingerprints in the Immigration Automated Clearance System because the machine will not read my prints clearly. I love outdoor but I cannot enjoy it especially during sunny weather due to fear of sweating.
It’s so troublesome and depressing because of this condition. I’ve read a lot of information about Hyperhidrosis and want to treat it permanently.
So here’s my question, can I opt first for Subdermal Laser to treat my sweaty armpits? Then I’ll go for Video Endoscopic Sympathectomy to treat my sweaty palms and feet after I save enough money for the operation? Or Video Endoscopic Sympathectomy will treat the 3 (hands, feet, armpits)?
Here’s my 2 cents worth. I do not think Subdermal Lasers work very well. Sympathectomy only works for the palms. However, one of the potential side effects of sympathectomy is that your armpits starts to sweat more. As far as I know, there isn’t any current good effective treatments for sweaty feet. Not what you want to hear I know however, I am not a surgeon. You should speak to a surgeon who does sympathectomies and get his opinion on this.
Hi Dr Tan,
I’m suffering hyperhidrosis on my armpit and want to do Botox, I just want to know how much will it cost? is it safe and painless?
Depends on how many units you need. Max 100 units which will cost $1500. It is safe but not painless.
Hi, may I know the price range for feet and armpit botox?
We do not treat the feet. For armpit most people will use a total of 100 units and that will cost $1500.
hello, How much to for face botox?
Depends on what you want treated. We charge $15 per unit.