It’s a complex word but all it means is excess sweating. This is not just sweating a little bit more than average; this is people who have their lives ruined by sweating. This means that they’re changing their shirts or blouses 4, 5, 6 times a day; they have to wear dark colors to hide the big wet patches under their arms.
They’re the sort of people who if they shake your hand, it feels like a wet fish; these people have a terrible life. Until recently, it was not even a subject that was really talked about…there was so little in the way of effective treatment.
The arrival of Botox has transformed that. Although it is only one of many options for the treatment of Hyperhidrosis – and I make it a policy to always discuss every option – there is little doubt that Botox has transformed the management of Hyperhidrosis.
And how does it do this? Well, it’s simple. Botox blocks the release of a nerve transmitter and the nerve transmitter affects muscle (and that’s why we use Botox to relax lines on the face) and this nerve transmitter, the same one, stimulates the production of sweat. So if we inject Botox in the underarm area we reduce the amount of perspiration from that area. And you have to remember when you’re talking about a sensitive subject like this, the old adage that basically: Horses sweat, Men perspire but Ladies glow… but if you’ve got Hyperhidrosis it’s just misery because it’s basically like a waterfall.
My approach to Hyperhidrosis is to do a sweat test and find out where the sweat glands are. We do that by painting iodine on the skin (as long as you’re not allergic) sprinkling on corn starch just as you’d sprinkle icing sugar on a sponge cake and then we sit back and wait. There is a magical reaction that occurs as the sweat goes through the iodine into the corn starch. It turns the corn starch black – brown black and it means I can map exactly where the excess sweating is! I actually use half the amount of Botox recommended by the manufacturer on my underarm patients simply because I take the trouble to do a sweat test, to find out where the sweat glands are and I take the tracing of the location of the sweat glands and I put it in your chart so we use the same tracing every time, so you don’t have to go through the palaver of iodine and corn starch every time you come.
The other big plus of Botox and Hyperhidrosis is it works longer on sweat glands than it does on muscle. If I’m injecting your frown lines it only works 3-4 months, maybe 6 months if you keep it up on a regular basis, but with Hyperhidrosis the average duration of effect is up to 7 months – and I’ve found in my practice for underarms because I do the sweat test most of my patients only have to come in once a year.