New Medicines, New Therapies to Stop Excessive Sweating!



Summer’s Closing But Still Excessive Sweating?
When underarm moisture becomes bothersome and beyond physiologic needs for cooling we say that it is excessive and apply the term hyperhidrosis. Hyperhidrosis (excessive sweating) occurs in women and men, it’s common. Hyperhidrosis may be an idiopathic condition with no specific cause, it could be due to a medical condition or medication. Hyperhidrosis is not typically a serious medical condition (you do have to stay extra hydrated,) but it can be significantly bothersome to you, and lead to excessive clothing damage! 

Sweating is our way of dealing with heat loss and it should be appropriate to the your situation. For instance, if you pop into a steam room excessive sweating is normal. But if you are just at work you shouldn’t have dripping seat of the feet, the face, your underarms, your hands, your scalp or ‘down there,’ or on your keypads.  Sweating also controls other glandular functions and skin functions. If you let this condition persist even skin in the non-sweating areas will not be as healthy. Eventually the skin in the worst areas of excessive sweat can actually become irritated and eventually breakdown in a process of being too moist. You can get excessive rashes, irritations, local maceration, extra skin tags, peeling skin, local viral warts, and other conditions that are really just due to the moisture. 
If you do have bothersome sweating, then it’s time to come in to Women's Health Practice to discuss. A quick set of blood work labs and medical evaluation can help determine if you need medical management, a bit of weight management, stress reduction, or hormone therapy.  If the bothersome sweating has persisted at least weekly, for over 6 months, seems to be on both sides of your body, and is a problem, then you may have Primary Hyperhidrosis. If you are in your 40s, you probably will not get this condition, most people have an onset before age 25. One sign of abnormal sweating is sweating that occurs at night. Sweating that is emotional almost always doesn’t occur during sleep as the higher brain centers calm their firing at nigh. 


Is is ok to Sweat with Hot foods, hot sex, hot yog? a
Hot foods, hot sex, hot yoga should all cause appropriate  sweating. When you eat hot or very spicy foods the sweating is usually facial lips, nose, or forehead, not really the underarms. Sweating should be water colored, there are a number of odd medical conditions that can cause you to sweat yellow, blue, green or even blac!  Colored sweat goes by the interesting medical name of Chromohidrosis. Snap a picture, email it in to us, and we will discuss!
Your Physiology Controls Your Symptoms
Do you have 2 million or do you have 24 million sweat glands? Either way, we can actually produce up to 10 liters of sweat a day. Impressive. It's necessary to have bacteria around to product the odors we think of as associated with our sweat. We do sweat salt with our water, but actually the ducts in the sweat glands reabsorbs most of the salt, so we don't lose enough to be dangerous, on a typical day. There are three cell types, the clear, the mucoid and the myoepithelial ones.

Our next step is to manage the sweating. There are topical medications that can be tried and Botulinum toxin type A (BTX-A), the medical brand Botox Being dehydrated will decrease your sweating but that is not a pleasant or healthy way to do it. Not moving much and of course being cool with air conditioning or in a pool will decrease the amount you perspire. There are medical grade antiperspirants that will help with this also.

For when that won't work you can use Botox. The ingredient in Botox which is Botulinum toxin it
.
Other Therapy
Now the treatments: antiperspirants are your first line of therapy, there are some topical medications that might work, in the list of topicals aluminum chloride and many of the OTC antiperspirants have this amount in them and are low cost.  There are prescription strength antiperspirants as well. The prescription strength is usually used daily, then interval of application for this product is increased and most stretch their medication. The antiperspirants work in an interesting way. They all contain a salt, that’s what the aluminum product is, and that salt gets in and ‘blocks the gland’ so that sweat is actually produced, but not discharged out the gland. For some people antiperspirants are so irritating we have to use
Next line therapy Botox, microwave thermolysis, oral medications, ultrasound  and surgery are all options. Surgery involves resection of the nerves of the area, and is a more aggressive and risky approach than most patients would be comfortable with.

Ultrasound Therapy

The ultrasound therapy Ulthera has been used off-label to treat excessive sweating. The treatments usually are a bit uncomfortable, possibly could cause some bruising, but there have not been serious complications reported from the treatment. Since no large trials have been done, it's not clear how long a treatment would last. Theoretically it could be curative.
Botox Therapy For Sweating
There are medical grade antiperspirants that will help with this also. For when that won't work you can use Botox. The ingredient in Botox which is Botulinum toxin prevents the actylcholine release and it's what is usually secreted in response to provoked reaction by your sympathetic nerves. This can be used under your arms, in the groin area, on the forehead or on the palms to decrease sweating. The most common use of Botox for decreasing sweating is under the arms, which is very effective, and only has to be repeated every 6-12 months for most individual. Risks and side effects can be discussed with your provider at your next visit, but it is a very safe injection. Most people will do well with 50 units on a side, and you notice effect in 2-4 days and then the average duration of effectiveness is about 30 months. Iodine testing to an area can help define the perfect places to treat.

Oxybutynin
New study reveals that a commonly prescribed medication may have a new indication to help those with excessive sweating. Oxybutynin is an oral medication that is a prescription that has been used for Overactive Bladder (OAB) and the incontinence some have with it. It will decrease secretions, and a main side effect is dry mouth. It has now been tested in doses between 2.5 and up to 7.5 for hyperhidrosis and over three quarters of women will report a ‘great’ response to the therapy.
To read about the approach the professionals at the International Hyperhidrosis Society support you can go to their website. https://www.sweathelp.org/

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