Stop The Sweat

ETS is a last resort method of curing excessive sweating by effectively switching it off via at the nerves.

How Does It Work?

The cause of hyperhidrosis is not exactly known but what is known is that it has something to do with the sympathetic nervous system. A sympathectomy is a method of actually cutting nerves so that sweating can no longer be “switched on”.

An endoscopic type or ETS is the most common method employed and involves less incisions and better recovery compared to older methods.

Typically, the entry incision is made via the armpit, regardless of where sweating occurs.

This type of surgery is never considered first for someone with a sweating problem. Even when surgical options are considered then liposuction to remove sweat glands is normally considered first because there is a lesser chance of side effects.

Controversy

ETS is highly controversial. Many doctors say that this type of surgery should not be performed. Yet at the same time, many surgeons say that it should.

The success rates from ETS vary and especially depend on the type of hyperhidrosis that is being treated. For instance, plantar hyperhidrosis does not respond well to ETS and only 30% of patients will get a good result. ETS is better suited to sweating of the hands, face and armpit. If it is performed for the feet then a non-standard procedure called a lumbar sympathectomy is required – this can lead to impotence for men and retrograde ejaculation (ejaculation into the bladder).

There are also said to be many side effects from ETS. A very common one is compensatory sweating. This is where the body decides to excrete more sweat from other parts of the body if it cannot sweat in the usual places due to ETS surgery. This type of sweating commonly happens on the trunk i.e. the chest and the back.

Anti-ETS Movement

So passionate do some people feel about this subject that there are even several anti-ETS movements on the internet.

If you are considering ETS then you would do best to get as many different views as possible in order to make your own balanced decision comparing the risks against the rewards.

Liposuction-curettage is a method of removing the sweat glands in axillary hyperhidrosis which is excessive sweating of the armpit.

How Does It Work?

It works by making a small incision in the armpit and then “scraping” the sweat glands from underneath the skin. It is only used for axillary type hyperhidrosis and many patients are said to be pleased with the results.

Alternatives

The alternatives to this technique include the older open surgery option and then shaving of the sweat glands. This is more traumatic, has a higher incision, higher risk of complications and requires a longer

recovery time. However, the recurrence rate of sweating is slightly better than for liposuction.

Another procedure called ultrasound aspiration liquefies fat and sweat gland tissue and has the lowest recurrence rates for sweating.

ETS is a much more invasive procedure with the potential for greater complication and involves cutting the nerves that carry the signals for sweating. It is highly controversial and many people advise against it.

You should also remember that there are many non-surgical options to consider before looking into liposuction. These include using prescription anti-perspirants such as Drysol or iontophoresis which can be carried out using sponges.

Repeat Surgery

Studies have shown that repeat surgery, where necessary, is successful if an aggressive canula is used.

The general public has in recent years become aware of Botox and its cosmetic uses. However, it has long been used to treat many conditions, including axillary hyperhidrosis (armit excessive sweating).

Botox is actually a trade name and one of many for botulinum toxin. In large doses it is highly toxic but in low doses it has a paralytic effect which has many applications.

How Is It Used For Hyperhidrosis?

Botulinum toxin is really only recommended for axillary type sweating. Sometimes it is used on the face or on other small areas. It is advised against for the feet as they are too large an area and require too

many injection plus the injections would be painful.

What Is The Procedure?

First of all the doctor will apply iodine to your armpits and then sprinkle a powder which will very quickly show up the location of your sweat glands in blue. Despite the overall armpit area, sweat actually only is excreted from a small rea about one to two squared inches.

Next he will inject the Botox into this blue area. There is a small amount of pain but not much. You will get about 12 injections into each armpit.

Side Effects

There are side effects with all drugs but these are rare. As long as you use a qualified doctor then you should not expect any major complications. Do not use a cosmetic surgeon for this treatment, especially do not ask someone at a “Botox party” to do this for you!

One side effect that is common with this treatment is compensatory sweating. This can happen with surgery such as ETS or liposuction sweat gland removal too. Compensatory sweating is where your body will divert the sweat from your armpits to some other part of your body – typically this is the trunk i.e. the chest and back area. Many people find that this is less of a problem compared to armpit sweating and the odor it produces.

Treatment is not permanent but it is usually effective for many months so a patient will typically desire to repeat it after around 6 months.

Iontophoresis is the application of a mild electric current to the skin. It has been used for many years to deliver drugs or even extract liquid from the body. However, for hyperhidrosis, simple tap water can be used.

Although delivering an electric current might seem antiquated or medieval at first, and conjures thoughts of electro-shock therapy for psychiatric patients, it is actually a highly successful method for treating specific types of hyperhidrosis.

The discovery was probably made by mistake because there is no scientific explanation for how or why

it works. However, there have been many scientific studies into this method which have concluded that it definintely does work, despite the lack of explanation.

Also, iontophoresis is best used for palmar and plantar hyperhidrosis and sometimes axillary.

The Procedure

A pair of small trays are filled with water and either the hands or the feet are placed into them. Submerged in each tray of water is an electrode.

Electric current then passes through the skin. It is very mild and no pain is felt, sometimes the sensation is described as being like “pins and needles”.

A typical treatment takes around 20 minutes. Most people need between 4 and 8 treatments to get the desired result.

How Long Does It Work For?

Typically, a patient can expect to keep their sweat at bay for several weeks at a time. The treatment can then be repeated again. Many patients who find this treatment works very well even buy their own kits to use at home – the equipment is actually fairly simple and cheap – someone with a basic knowledge of electricity could even create their own if they wanted to!

Other Notes

Sometimes people use a chemical instead of tap water and they have reported good results. for instance, gycopromium bromide is one such chemical that studies have found to give a significant improvement.

No one really knows why this technique works but it is thought that perhaps the ducts that carry the sweat are temporarily blocked due to the electric current.

Pro-Banthine, or to use it’s chemical name propantheline bromide, is not usually the first drug that people turn to in an attempt to control their sweating. However, it is one of a number of drugs that a struggling patient can try and it may suit some very well.

What Does It Do?

This drug is more commonly used to help people suffering from involuntary urination or cramps of the stomach or bladder. However, it is also used for people with irritable bowel syndrom and excessive sweating.

How Does It Work?

It works by inhibiting the action of a chemical called acetylcholine in the parasympathetic nervous system. What this means is that sweat and tears are reduced due to this, hence why some

hyperhidrosis patients may look at this.

Dosage

The typical dosage is 15mg three times a day plus a further dose of 30mg at bedtime.

Side Effects

There are some known side effects, as with all drugs, such as increased heart rate, drowsiness and blurred vision.

Ultimately, this is another potential drug tool that can be used to help hyperhidrosis sufferers. If the usual first steps fail such as antiperspirants, then Pro-Banthine should be considered.

Beta blockers can be useful for those patients where anxiety is a major trigger of excessive sweating.

How Do Beta Blockers Work?

Beta blockers work in a very different way to anti-depressants. Whereas antidepressants work on the brain chemistry and particularly serotonin, beta blockers work on the sympathetic nervous system. This is considered to be the core area that is different in hyperhidrosis sufferers compared to everyone else.

Beta blockers work by blocking the action of some key chemicals in this system, especially adrenalin and non-adrenaline. In many ways, anxiety is a response to a stimulus. By blocking the actions of these

chemicals, the anxiety or the anxious response in the patient is prevented and they do not excessively sweat.

Compared to antidepressants, one key advantage is that they can be taken as required and do not require days or weeks to build up their effects. So, if a hyperhidrosis sufferer has a major public speaking event coming up then they can take a beta blocker before it.

Side Effects

There are unfortunately some well known side effects of beta blockers such as drowsiness, some brief memory loss, diarrhea and lethargy.

However, unlike antidepressants, they are not habit forming and there are no withdrawal symptoms associated with them.

For many hyperhidrosis sufferers, anxiety it usually a trigger to sweat more and can even be responsible for most of the sweating. Whereas all human beings sweat under conditions of anxiety (the basis of the lie detector test), people with hyperhidrosis will sweat profusely in a very obvious manner.

This also creates a vicious circle. The expectations of the trigger being activated can in themselves cause anxiety and excess sweating. It’s clear that if the anxiety can be controlled or eliminated then the quality of life for someone like this can be increased.

Treatments

Typical treatments for anxiety are well known. Most doctors will prescribe one of the large family of SSRIs (selective serotonin reuptake inhibitors) that have been prescribed for many years for millions of people to good effect.

Alternatively, some doctors may prescribe the older class of drugs known as tricyclic antidepressants.

The reason that your doctor may experiment with you between the different types of drugs is to try to control possible side effects.

Side Effects

All drugs have the potential to cause undesirable side effects. The worst of these only occur in a very small minority of patients.

However, for hyperhidrosis sufferers there is the problem that some of these drugs can actually cause excessive sweating, particularly during the night. This is the reason why your doctor may well ask you to try a drug and report to him the degree to which your anxiety diminished and whether you have had any sweat related side effects. If you have, then you can change your medication to a similar but different drug and this type of change is well tolerated.

Topical antiperspirants are usually the first line of defence for someone with excessive sweat.

Over The Counter

As you probably already know, there are many over the counter products available. While these work for the general public, they are largely not strong enough to counter the sweat of hyperhidrosis sufferers.

Also, they are usually only intended to be applied to the underarms and not anywhere else.

Prescription

Prescription antiperspirants can be used anywhere on the skin, so long as it is not broken or overly sensitive. Like the over the counter versions, they contain aluminium chloride which has been long

established as an effective way to stop sweat production. However, these prescription versions have much higher concentrations.

Although there are many brands, the most commonly prescribed and well known brand is Drysol.

Directions For Use

Drysol can be applied anywhere where there is excess sweating. This includes the hands, face and soles of the feet.

It is best applied at night time. First ensure that the skin is dry.

Apply Drysol and let it dry out before going to bed.

It should be used for 2 to 3 nights in the first week and then once per week thereafter.

In the morning, you should wash the affected area clean.

Many people report a slight itching, burning or prickly feeling from Drysol. However, it is still considered worth using and most people with hyperhidrosis will report their problem solved with Drysol. Only a minority need to try other methods such as surgery or Botox. Also, if you are pregnant or breastfeeding, be sure to tell your doctor as this could have implications.

Cranio-facial hyperhidrosis is excessive sweating of the face, scalp and the neck.

Features

This is a condition which obviously presents many social difficulties. It is also commonly seen at the same time as erythrophobia or excessive blushing.

Difficulties

Along with palmer hyperhidrosis, this type of excessive sweating presents great social difficulties for the patient. Often, they will develop social anxiety which only serves to make the problem more worse than it originally was.

Women in particular face even greater problems and many of them cannot wear makeup which would other smear very quickly.

Sufferers will also not be able to blow dry their hair due to the heat generated. Even a cool setting can present problems.

Treatments

Beta blockers can be used to treat cranio-facial hyperhidrosis, especially if it is largely triggered by episodes of anxiety.

Studies have also found that anticholinergics such as glycopyrrolate have proved to be very useful in treating this form of excessive sweating. However, such drugs do have potential side effects such as dry mouth, headaches and diarrhea.

Botox, or rather botulinum toxin, is also effective. It is most effective for small areas of localised sweat. If the entire face, scalp and neck area is affected then it may not be practical due to the large number of injections that would be needed.

As a last resort, a sympathectomy may be carried out. This is a type of surgery normally carried out with small incisions and an endoscope (ETS) where specific nerves are cut to block the signals that activate sweating in specific parts of the body. This type of surgery is highly controversial so only consider it as a last resort and do plenty of research beforehand.