This article was sponsored by Allergan Aesthetics, though, the content therein is based on Dr Xen Ludick’s professional experience and opinion.
The hero of the movie is trembling, sweat dripping from his forehead. The clock connected to the bomb is counting down: 14, 13, 12… He has a small pair of pliers ready to cut the wire that will stop the bomb’s clock and save the world… again.
Sweat is now dripping from his chin.
The time has come.
He is going to cut the green wire.
No, the red.
No, the green.
He has to decide.
It’s at 5, 4, 3…
Okay, red it is.
His hands are too sweaty! The pliers slip out of his hands and…
“KABOOM!”
Too late.
Sweat much?
Sweating under normal circumstances is normal. But what is “normal”?
When the sweat glands produce perspiration under conditions of exercise, heat, severe stress and anxiety, sweating is usually a normal occurrence. It is regulated by what is referred to as your autonomic nervous system. This basically means that it is automatic and we cannot control it. Almost like the climate control in your car. Once you’ve set it to 22°C, it will endeavour to keep your car’s temperature at 22°C.
Living with hyperhidrosis
But what if the body’s climate control doesn’t work effectively and goes up to 40°C at random times? Well, this is exactly how hyperhidrosis feels to people who suffer from this condition, where they sweat at the ‘wrong’ and inappropriate times. Indeed, hyperhidrosis can be so severe that you cannot hold on to a pen, are forced to wear two, sometimes three, layers of shirts to hide your sweat marks, or even slip around in your shoes because they are so wet. Needless to say, it can be extremely debilitating.
Additionally, sufferers from hyperhidrosis sweat even more with regular stimulants such as heat, spicy food and stress – thus making a simple action such as shaking someone’s hand (pre-COVID, obviously) even more stressful. It was previously thought that people who were prone to anxiety and stress would be more prone to sweating excessively. However, it has subsequently been proven that hyperhidrosis is more likely the cause of your stress and anxiety – and not the other way around.
Hyperhidrosis types
Excessive sweating most commonly occurs on the palms of hands, soles of feet and under the armpits. Broadly, there are two types: the type where no true cause can be found (primary/ idiopathic), and the type where there is an underlying condition, such as an overactive thyroid, diabetes, gout, obesity or menopause (secondary).
This means that hyperhidrosis can be a symptom of something more sinister, and therefore may require treatment. So, don’t just assume its idiopathic – chat to your medical doctor.
When to treat
When deciding on a treatment strategy, there are few factors that can help you decide on a potential route to take.
First, how bad is my sweating? Does it:
- Influence my personal/professional life?
- Cause me to withdraw socially?
- Often cause skin irritations like fungal infections?
- Cause me to wear darker clothes, or sees me changing shirts during the day?
- Cause me to avoid physical contact?
Second, have the following options failed?
- Strong anti-sweat agents like Drichlor
- Avoiding spicy food and lessening alcohol intake
- Weight loss if overweight
- Avoidance of synthetic clothing that can cause sweating
- Using natural shoes like leather instead of synthetic
- Using armpit shields inside clothes.
If the conservative measures have failed, it might be time to consult with a medical doctor about excessive sweating. Your medical doctor will discuss the different treatment options available – from medication (with its potential side effects of blurred vision, dry mouth, dizziness, urinary issues and dry eyes) and surgery (cutting of the nerve that supplies the affected area), to electric treatment (where the sweat glands are deactivated by an electric current) or neurotoxin treatment.
While oral treatment can be prescribed by your general practitioner or specialist, the surgical option is quite invasive and is usually performed by a cardio-thoracic surgeon.
Injections for underarm sweating
Your medical doctor will probably request that no anti-perspirant be used on the day of treatment in order to more accurately determine the extent of sweating. They may also request that no alcohol and/or coffee be consumed from the day prior to your visit.
Your armpit will be assessed for sweating prior to treatment, to determine the extent and the concentrated areas of sweating. This test is done with some starch and iodine, so expect some white powder and, potentially, iodine on your armpits. Don’t wear your finest top to this session, just in case.
After the test, your medical doctor may take photos of the affected area to be able to gauge the result after the treatment has kicked in. Some medical doctors may opt to draw a grid in the area with a skin marker to more accurately determine the spread of the effect of injection, across the affected area.
The treatment itself is done with a very small syringe and needle with small volumes of the medicine injected right under the skin, approximately 1 cm apart. This procedure is tolerable for most people and takes about 10-20 minutes in total. Some doctors will use ice as an anaesthetic too.
There is minimal to no pain afterwards and bruising is uncommon. Most patients say that the mild discomfort is absolutely worth it!
Post treatment
Within 14 days, you will start to see an effect, and most medical doctors will do a follow-up after that time to assess the result. If more is needed, it can be done at the follow-up consultation.
There have been multiple studies done to determine the efficacy and duration of injections on excessive underarm sweating.
They have shown that not only is there a significant reduction in sweating after treatment but has also proven the procedure to be very safe – with results tending to last 2-6 months! Furthermore, some medical aids might cover the cost from your savings (chat to your medical aid first).
Final thought
I can, with absolute surety, say that this is a very effective option for underarm hyperhidrosis. It’s a very satisfying treatment to offer due to the results and a high level of patient satisfaction.
Always ask your medical doctor for more information and medical advice.
Disclaimer: This article was sponsored by Allergan Aesthetics, though the content therein is based on Dr Xen Ludick’s professional experience and opinion.
This article is published for information purposes only, nor should it be regarded as a replacement for sound medical advice.
MBChB
- General Practitioner with a special interest in aesthetic and anti-ageing medicine
- Member of the Allergan Medical Institute Faculty
- Adv Dip in Aesthetic medicine (Cum Laude)