Sweaty-Betty (or Bill): What to Do When Perspiration is a Problem

Sweaty-Betty (or Bill): What to Do When Perspiration is a Problem
Woman with overly sweaty armpits

There’s a time and place for all things. For example: sweat. Totally appropriate at CrossFit, a hot yoga class or on a grueling summer hike. Not entirely appropriate when you’re shaking the hand of a new client, soaking through the underarms of your shirt in a presentation, or just… you know… standing there minding your own business. So today we’re going to talk about abnormally excessive sweating—what it is, what it does and what you can do about it.

What causes abnormally excessive sweating?

The proper term for abnormally excessive sweating is hyperhidrosis. Hyperhidrosis is a disorder that causes abnormally excessive sweating of hands and feet, underarms, and the face that is typically unrelated to body temperature and exercise. It affects between 2-3% of Americans, and while it can be tied to an underlying disease, it typically occurs in otherwise healthy people. Some patients who suffer from this disorder find that the waterworks are triggered by heat or emotions like anger or anxiety, but in many cases patients with hyperhidrosis simply sweat all. day. long. regardless of mood, temperature or physical activity.

What’s the big deal?

If you don’t suffer from hyperhidrosis, you might think, “What’s the big deal? It’s just a little sweat, right?” Wrong. Totally wrong. Hyperhidrosis, while not in and of itself a serious medical condition, can cause a variety of worrisome problems, from skin conditions to significant emotional distress. Patients report avoidance of social, romantic and professional opportunities due to embarrassment over excessive sweating. Some patients also find it difficult to grip a pen or a steering wheel due to wet palms. Hyperhidrosis can cause a variety of skin issues exacerbated by consistently moist skin, things like jock itch and athletes foot, warts and body odor all clock in as unpleasant problems associated with abnormally excessive sweating. And don’t get us started on the damage it can do to a wardrobe that’s consistently being soaked and stained with sweat.

What can you do?

For those suffering with hyperhidrosis there’s good news. Medical techniques have advanced to include both surgical and nonsurgical solutions to treat excessive sweating from topical to injectables to procedures. So let’s take a look at some of the most common and effective sweat reduction and hyperhidrosis treatments your doctor can use to block or disable those weepy geysers some of us call sweat glands shall we?

Nonsurgical Treatments:

  • Topical & Oral Medications: Doctors treating hyperhidrosis will likely recommend that sufferers first try an assortment of prescription and non-prescription antiperspirants and/or oral medications to try to reduce the sweat. Antiperspirants that contain aluminum chloride are sometimes more effective than other over-the-counter antiperspirants. Should that fail, prescription-strength antiperspirants that contain chloride hexahaydrate can be even more effective. There are also oral medications called anticholinergics that can help reduce sweating, but which come w/ side effects like blurred visions, dry mouth and urinary retention.
  • Iontophoresis: Next up is a treatment called iontophoresis, in which water is used to pass electrical currents through the skin to block the production of sweat. Say the problem area is your palm or foot. Iontophoresis treatments would consist of immersing the hand/foot in a shallow water tray for 20-40 minutes in which time the Iontophoresis device would send a mild current through the water too effectively prevent the production of sweat. About 10 sessions, spaced between 2-3 days apart are necessary for the best result and maintenance sessions spaced 1-3 weeks apart are also required.
  • Botulinum toxin injection (Botox, Xeomin, Dysport): Botulinum toxin injections block the nerve's control of the sweat glands and are most commonly used to treat axillary (underarm) hyperhidrosis. It is also occasionally recommended to treat excessive sweating in the hands, feet and face. Your plastic surgeon will inject small amounts of the Botox into the armpit with anywhere from 20-50 injections. Comfortable? Not entirely. But this treatments ability to provide up to 14 months of relief from all. that. sweat. might just make it worth it.
  • Microwave technology (MiraDry): Microwave technology was approved by the FDA in 2011 to treat excessive hyperhidrosis and is increasingly viewed as an effective noninvasive treatment for excessive sweating and underarm odor. During this procedure, your doctor will use a handheld device to suction the skin and bring the glands as close as possible to the microwave energy the device emits. Then heat energy is targeted on the glands, damaging them and their insidious ability to soak through a shirt in record time. This procedure is also performed in a series of 2-3 treatments with the use of local anesthesia and skin cooling to help with any discomfort.

Surgical Treatments:

  • Axillary shaving: This procedure involves the use of an arthroscopic shaver (a long, thin cannula-like tube with blade at end) which is run underneath the skin to 'shave away' sweat glands. Axillary shaving is a surgical procedure, so it’s permanent. And similar to liposuction, your doctor will need to make one small incision in each armpit, which will leave an almost imperceivable scar and will not disrupt the hair glands.
  • Laser ablation (VaserShape, Cellulaze, SlimLip): Along the same lines, laser ablation uses laser cannula directly underneath the skin to heat and disables the axillary sweat glands in the armpit. Your plastic surgeon will again need to make one small incision in each armpit, and will perform the procedure under local anesthesia. Results are permanent, and the laser technology used can damage some underarm hair. So, you know, FYI.

A sit down with your board-certified plastic surgeon will start you on the path to getting any overly aggressive sweat glands under control.