Nothing but the truth! Palmar and plantar HH By Dr Davin Lim...
Surgery for excessive sweating is a big step and patients will need to think carefully before embarking on this journey.
Conservative treatments should be tried first before surgery is considered.
Have you tried other treatments for your sweating?
Palmar Hyperhidrosis patients should consider: Iontophoresis or sweat stopping treatments
Facial and scalp hyperhidrosis patients should consider: sweat stopping treatments or creams
Axillary Hyperhidrosis patitents should consider: sweat stopping treatments and antiperspirants
Surgery can be helpful if patients suffer from several areas of excessive sweating. Examples include- sweating of the hands associated with underarm sweating, or facial sweating coupled with flushing.
Surgery as advantages over treatments such as iontophoresis, antiperspirants such as DRICLOR and even sweat stopping treatments!
Surgical procedures such as ETS (endoscopic thoracic sympathectomy) have high success rate, and once performed, sweating can be cured. The procedure, if successful, can be considered permanent. ETS is especially useful if there is excessive sweating on the hands, as well as the armpits. ETS is also very successful if sweating of the face, neck and scalp is associated with blushing.
Localised surgery to destroy sweat glands is hardly ever performed. Procedures such as excision, liposuction, curretage and laser to the sweat glands of the armpit has a high rate of complications including scarring, contracture, and bleeding. Localised sweat gland surgery has been replaced by sweat stopping treatments or ETS.
For ETS the actual surgery itself is very safe. Your Vascular surgeon will discuss the risks of surgery including Horner’s syndrome, pneumothorax, and the risks of the general anaesthetic.
Patients who under go ETS surgery will also need to consider that a high percentage of patients may also suffer from COMPENSATORY HYPERHIDROSIS. This means that even though your hands, underarms, face, neck or scalp may stop sweating, other areas of your body may sweat excessively, which ‘compensates’ for decreased sweating elsewhere. Compensatory sweating can be seen in up to 60% of cases of ETS.
Surgery for underarm sweating should be reserved as last line management for excessive underarm sweating. As a rule, patients should try less invasive procedure, that carry little or no risks of side effects.
The use of over the counter antiperspirants such as DRICLOR is considered first line treatment of underarm sweating. These work by blocking the eccrine sweat unit, reducing sweat production. Antiperspirants work best for mild underarm sweating, patients who suffer from moderate to severe sweating will usually develop skin irritation. The correct use of DRICLOR can reduce skin irritation in some patients.
Sweat stopping treatments
sweat stopping treatments injections are second-line treatment for severe underarm sweating. Sweat stopping treatments can only be indicated if antiperspirants do not work, or if you get skin irritation secondary to DRICLOR. Sweat stopping treatments are injected into the deeper layers of the underarm skin, targeting sweat glands. It works by temporarily blocking chemical signals that stimulate the eccrine glands. When these glands don’t receive the signals, sweating stops.
Sweat stopping treatments takes 5-10 minutes to perform, and takes upto 2 weeks to work. In the context of reducing underarm sweating, it usually lasts 6-7 months. Side effects are minimal, and treatments are partially covered under Medicare.
Prescription tablets such as anti-cholinergics can help reduce sweating, however they have to be taken up to three times a day. Most patients will develop side effects such as sedation. In higher doses side effects such as blurred vision and dry mouth syndrome can occur.
Natural remedies, alternative therapies and meditation
We encourage patients to try natural remedies if they are open to it! In reality, only a very small percentage of patients will respond. Chamomile, valerian weed root, and sage tea can reduce sweating, with the highest success rate seen in mild cases of underarm sweating. Other techniques to reduce sweating include biofeedback, and relaxation techniques.
It is now widely recognised that sweat stopping treatments injections is the second line treatment for underarm or axillary sweating. Most cases of moderate to severe underarm sweating do not respond to antiperspirants such as Driclor, and sweat stopping treatments is then indicated.
Sweat stopping treatments for underarm sweating takes only a few minutes to perform, and involves a series of injection in each armpit. Apart from some mild stinging, swelling and skin redness, treatments are safe and free from side effects.
You should however tell your dermatologist if you have the following conditions:
Pregnancy or plans to become pregnant. We do NOT perform sweat stopping treatments in pregnant women
Breast feeding, as sweat stopping treatments may pass into breast milk
Any disease that may affect your muscles, this includes Lambert-Eaton syndrome, ALS, or amyotrohic lateral sclerosis, or any other neurological disease
Previous reaction to sweat stopping treatments or Dysport
Medications including asprin, warfarin or anti-inflammatories
On average, sweat stopping treatments treatment lasts up to 201 days, or 6.7 months. As a guide we usually say 5-7 months. We have some patients who have sweat stopping treatments that lasts up to 10 months. This treatment is not a cure, but patients will know when the time comes for a top up treatment.
Sweat stopping treatments injections in the context of treating underarm sweating carries little if any side effects. For obvious reasons, pregnant women or breastfeeding mothers are excluded from treatment.
Side effects such as infection, bruising and bleeding is seen in less than 1% of cases.
Dr Davin S. Lim
Westside Laser and Cosmetic
Sweat Free Clinics
Surgical methods for sweat correction has changed markedly over the past decade. Initial methods involved cutting out the armpit vault. This procedure resulted in marked scarring, and contractures. Liposuction was used a decade ago, followed by curettage destruction of sweat glands. This was followed by Erbium laser with the liposuction technique. When things fall in place and go right, these surgical techniques were excellent in permanent reduction of underarm sweating, however the risks of surgery are significant.
Now a days we have learned more in regards to safer methods to treat underarm sweating. Non-invasive methods such as sweat stopping treatments injections are considered Gold standard in the initial management of underarm sweating. The question now arises, where does surgery fit in the scheme of things?
Well, there is a place for surgery. ETS or endoscopic thoracic surgery can be a excellent method of treating hyperhidrosis. Most surgeons agree that is last resort surgery for underarm sweating, however maybe a treatment worth considering if you suffer from excessive facial sweating, or from sweaty hands. It can also be an excellent form of treatment if patients suffer sweating from multiple areas, including the armpits, face and hands. The advantage of surgery is that if successful, it is permanent, unlike sweat stopping treatments which has to be repeated every 6-7 months.