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SWEATING UP A STORM? Botox may be the answer!

15 November 2019

Kristy Johnson is your average 18-year-old fun-loving teenager. Finishing high school and looking forward to the next phase of higher education. She plays basketball and loves music. In all respects, her life would seem to be normal; however, Kristy is plagued by a medical problem that few of us think about. She suffers from excess sweating. 

Kristy’s problem began several years ago out of the blue when she started noticing excess sweating from her underarms and then from her hands and feet.

And this was not just sweating in response to being nervous/emotional or overheated. It was sweating that could occur at any time or any place quite spontaneously and continuously with no apparent trigger. She would sweat so much that she would have to carry extra T-shirts with her to school or whenever she was away from home. It was quite an embarrassment for her but also a significant nuisance. She had difficulty in activities and social settings always self-conscious of becoming drenched in her own sweat. She had trouble developing relationships with boys as holding hands became a sweaty mess. She felt like a leaky roof with no way to correct the crack.

The name of Kristy’s medical condition is hyperhidrosis, and for the majority of patients, the cause is unknown.

In some patients, it can be related to other medical conditions and is then called secondary hyperhidrosis. The excess sweating can affect specific localized areas or the entire body. The localized sites most commonly affected are the palms, soles, and underarms. For years, Kristy had primarily ignored her condition, hoping it would just go away, but it did not. She tried every antiperspirant at the drug store, but the sweat kept coming. Frustrated and wanting to do something about it, she sought medical help.

When Kristy finally did seek medical attention, we confirmed the diagnosis of primary hyperhidrosis and ruled out other possible medical causes. Typically her type of hyperhidrosis starts during childhood or adolescence and persists throughout life. Nervousness and anxiety can elicit or aggravate this form of excess sweating, but psychological/psychiatric disturbances are only rarely the cause of the disorder. 

The treatment for Kirsty’s hyperhidrosis mainly fell into two broad categories; medications or surgery.  

Medical treatment can involve the use of prescription-strength antiperspirant. Aluminum chloride is commonly used and applied to the skin overlying the sweaty areas overnight. This represents the simplest form of therapy available. It may provide temporary relief, but it is often cumbersome for the patient to follow through with.

Oral medications can be used to treat hyperhidrosis. These medications, called anticholinergics, will diminish sweat production but may be unappealing because of their side effects which include blurred vision, dry mouth, and difficulty urinating.

Iontophoresis can be tried if antiperspirants have not lead to the desired result. This method consists in applying low-intensity electric current to the palms and/or soles immersed in an electrolyte solution. The procedure has to be repeated regularly. The results vary: many patients, suffering from light or moderate hyperhidrosis, are happy with the method, but some may consider it too time-consuming or inefficient, and comparably expensive. 

Botulinum toxin injections (more commonly known as Botox) are the newest form of treatment for hyperhidrosis. Botox, usually popularized for the treatment of wrinkles, is quite effective in the treatment of hyperhidrosis. 

Botulinum toxin is a neurotoxin that has a specific affinity for nerves supplying sweat glands. By injecting Botulinum toxin into the areas of excess sweating, one can effectively temporarily shut off the “fuel” driving the “fire” of sweat. 

The procedure is extremely safe, and potential side effects are minimal.

The treatment itself takes 30 minutes and can be performed in the office. Numbing medication is usually applied to areas being treated before the procedure to minimize any discomfort. A series of small needles are injected into the areas of excess sweat. The patient can return to work or school the same day. With this treatment, sweating can be diminished or halted for up to 6- 8 months. The results can be dramatic and life-altering. Although expensive it is being covered by many private insurance plans and is becoming one of the more commonly used treatments for this condition.

Surgical treatments can also be used to treat hyperhidrosis, but they tend to be somewhat drastic and reserved for the most severe cases that have not responded to other forms of less invasive treatment.

After discussing the various treatment options available to Kristy, we elected to treat her underarms with Botox injections. 

The procedure was extremely well tolerated and with very minimal pain. She has remained free of excessive sweating for 8 months. Botox is not a permanent cure for hyperhidrosis, and she will require repeat treatments, but in Kristy’s own words, “it’s worth being dry.”  

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Dr. Samir Gupta

Dermatologist

Dr. Gupta MD, FRCPC is a board-certified Dermatologist practicing in the greater Toronto area. He completed medical school at the University of Toronto and dermatology training at the University of Chicago and Harvard University. He is the Clinical Director of HeartLake Cosmetic Dermatology with 15 years of experience treating patients from all over Canada.