Dr Karl Ng Hyperhidrosis

Hyperhidrosis is a benign disorder (of no danger to health); however, it carries serious implications for an individual’s quality of life and psychosocial wellbeing. Improving quality of life is a key treatment goal.
Is there a typical hyperhidrosis patient?
Can affect roughly 1/70 in the population regarding the areas of the armpits. It’s very common; often a family history and we don’t usually have any particular sex predisposition with this condition. Usually comes on in the teens, regardless of the fitness level or body constitution.

What impacts does hyperhidrosis have on the quality of life?
Multiple impacts on people’s quality of life. This is a fairly under recognised condition. Just in terms of its local affect, people find it hard to keep the area clean and dry. There may be laceration or break down of the skin. In functional terms, patients often find that when they’re doing their work or activities of daily living they have to swab the area frequently, visit the toilet often to perhaps use the dryer or paper towels beneath the arms and will find their shirts may be ruined. They may find they prefer to wear dark coloured clothing rather than light coloured clothing and they may actually find that they will ruin their shirts.

What psychological impact can hyperhidrosis have?
The way patients have to adapt their life to actually cope with their excessive sweating can cause clinical depression in some. Generally speaking it can be quite a nuisance, they’ve often seen their GP or medical practitioner or some may be too embarrassed to even speak about it. Sometimes they’ve sought professional help but have been told that its stress or that they’ll grow out of it.

What options are available to treat axillary hyperhidrosis?
Most medical practitioners would regard the first treatment line for axillary hyperhidrosis would be to use local therapies. Patients will often have tried deodorants or antiperspirants that are available over the counter. The next line would be high dose aluminium containing preparations. These have the effect of blocking the sweat glands. However by the time they have come to see myself or a specialist for this condition, these usually have failed or have caused excessive irritation to the skin and the armpits. Therefore other treatments are warranted. Most practitioners would feel that this point in time that a good option which has been available for some time now would be the use of botulinum toxin A injection therapy. This consists of minute intradermal injections to the skin.

How does Botox treat axillary hyperhidrosis?
Well it’s interesting, we’re all aware of the use of toxin in cosmetic procedures.  It works in a similar fashion in that it blocks the signals from the nerve to sweat glands in this instance rather than to the muscle.

What steps should someone experiencing severe underarm sweating take?
There are two requirements for patients to access this treatment: first of all they need to have tried high dose aluminium topical treatments to the underarm regions for at least two months to be entitled under the PBS. Secondly, they should seek a referral from their medical practitioner to a specialist who is a licenced botulinum toxin injector.

Article kindly reviewed by
Dr Karl Ng MB BS (Hons I) FRCP FRACP CCT Clinical Neurophysiology (UK)
Consultant Neurologist – Sydney North Neurology and Neurophysiology (download referral form and map); Conjoint Senior Lecturer – Sydney Medical School, University of Sydney; and Editorial Advisory Board Member of the Virtual Neuro Centre.
 

More information

For more information about hyperhidrosis, including symptoms, treatments and how to live with the condition, see Hyperhidrosis.