what causes it?
Excessive sweating or hyperhidrosis occurs in 1% to 2% of the population. These poor patients sweat even when the circumstances don’t call for it. Most cases of excessive sweating are harmless, however profuse sweating hyperhidrosis can result in skin maceration and secondary infections.
Primary or focal hyperhidrosis
Excessive sweating in the hands, underarms, face, and feet
Secondary or generalized hyperhidrosis
Excessive sweating all over the body or in a larger area of the body, more likely to cause sweating during sleep or be caused by excessive heating, medications or medical conditions such as:
- Parkinson’s disease
- Rheumatoid arthritis
to treat excessive sweating safely and effectively
Neurotoxins inhibit release of acetylcholine at the neuromuscular junction, preventing the hyperstimulation of eccrine sweat glands that leads to excessive sweating. They have a rapid onset of reduction in sweating and effects lasting for months.
Fractional Microneedle Radiofrequency
Fractional microneedle radiofrequency uses insulated microneedles to spare the upper part of the skin and deliver radiofrequency energy precisely to the sweat glands deep in the skin, leading reduction in functional sweat glands. Some patients may require up to three procedures to achieve significant long-lasting sweat resolution, however many patients will start seeing improvement after one treatment.
- Over-the-counter or prescription-strength antiperspirants
- a low-intensity electrical current treatment called iontophoresis
- acetylcholine blocking medications that affect the nerve signals to sweat glands
- limited temporary effectiveness
- usually the last resort for severe hand and underarm sweating
- may involve removing sweat glands or cutting of the nerves responsible for sweating (thoracic sympathectomy)
- significant and longer lasting effects but require downtime for recovery
- involving much greater risks such as nerve damage or compensatory sweating
dr wan's perspective
Patients suffering from hyperhidrosis can sometimes be deprived of simple things like holding their loved ones’ hands, or having to struggle with embarrassment in social situations such as giving a speech or sweaty pit stains in their clothing. Dr Wan deeply empathizes with their suffering.
In Dr Wan’s view, it is important to first assess the patient holistically looking out for causes of hyperhidrosis in particular, especially when larger areas are involved. If no secondary cause is found for generalized hyperhidrosis, generally oral medications would be prescribed as it may be difficult to treat large areas with other therapeutic options.
For focal hyperhidrosis, patients often feel frustrated with non-invasive approaches that may be cumbersome or ineffective, and yet may be afraid to undertake the serious risks of invasive surgery that may end up ineffective in the end.
- Neurotoxins are a good alternative and can be used in most areas.
- When used in the palms and soles, good anaesthesia is critical to achieving patient comfort and Dr Wan usually advocates the extra step of regional nerve blocks that make things much more tolerable.
- For underarm sweating, Dr Wan prefers to use fractional microneedling radiofrequency that has minimal downtime and a more permanent effect compared to neurotoxin treatment