"Over the past year (we've) been hearing lots of radio ads
about excessive sweating...definitely the fruits of a busy
PR firm, I'd say. The solution? Botox, among others... "
speaker snipped.
New Treatments Turn Off the Tap for People Who Sweat Too
Much
By KATERINA A. CHRISTOPOULOS
Published: April 20, 2004
New York Times
Bronwynn Hayles was born with sweaty palms.
As a child, she dreaded the moment when the teacher told her
to hold hands in a circle. Turning in homework was a
nightmare.
"The sweat from my hands would soak through the paper so it
would be dripping wet," Ms. Hayles recalled.
The problem was so bad, she said, that over the years she
sought help from a series of doctors. "They would just
laugh," she said. "I was told that there was no hope."
Seven million Americans suffer from hyperhidrosis, or
excessive sweating, in which people produce up to five
times the amount of sweat required to regulate body
temperature — enough to derail a romantic dinner or wreck a
business meeting.
Until relatively recently, people with hyperhidrosis
suffered silently — and wetly.
But the availability of new treatments, including Botox,
widely expected to win approval this year from the Food and
Drug Administration, along with a growing realization that
excessive sweating can be socially debilitating, has drawn
increasing attention to the disorder in medical circles.
Last year, a multidisciplinary group of physicians founded
the International Hyperhidrosis Society to promote education
about the disorder.
This year, the annual meeting of the American Academy of
Dermatologists devoted a forum exclusively to the subject
for the first time.
"We felt there was a real need for both public awareness and
physician education," said Dr. David M. Pariser, a professor
of dermatology at the Eastern Virginia Medical School in
Norfolk, who is president of the society.
"Having treated patients with hyperhidrosis," Dr. Pariser
said, "you find that the stories patients tell about the
impact of this disease are really amazing."
In one case, Dr. Pariser said, a mother lamented that she
kept dropping her baby because her hands were so sweaty.
"We want people to know there is treatment available that
can change people's lives," Dr. Pariser said.
The sense of isolation and frustration that accompanies
hyperhydrosis is often devastating.
Kristin Behrens, 34, who works in banking in Chicago,
remembers going to elaborate lengths to hide her problem,
wearing only dark colors and certain fabrics.
"I would rip out all the pocket linings in my clothes and
sew in washcloths, so I could stick my hands in there and
soak up the sweat,"
Ms. Behrens said. "I would always hold a large drink of cold
ice water, so I would have a built-in excuse for my
hands' being cold or wet."
Mt. Hayles and Ms. Behrens have idiopathic, or primary,
hyperhidrosis, which usually begins in childhood or
adolescence. The sweat glands are normal, but for some
reason the central nervous system responds in an
exaggerated manner to triggers that can set off sweating
like emotional stress or hot weather.
The precise cause of primary hyperhidrosis is not known, and
the disorder typically affects limited areas of the body
like the armpits, the palms and the soles of the feet.
Another defining characteristic is that it does not occur
during sleep — in contrast to night sweats, a symptom that
can suggest an infection. Frequently, patients have family
histories of excessive sweating.
Traditional treatments for hyperhidrosis have included
antiperspirants, among them prescription-strength formulas
like Drysol, and iontophoresis, the process of applying
electrical current to the skin through tap water, blocking
the sweat glands.
But antiperspirants can irritate the skin, and iontophoresis
treatments can take up to a half-hour each.
Some doctors prescribe drying medications like oxybutynin
and glycopyrrolate, which block a neurotransmitter,
acetylcholine. Those drugs reduce sweat and dry
secretions in all parts of the body, including the mouth
and the vagina.
Drugs like Prozac, Valium and the beta blocker Inderal have
also been used, with little success.
Mu. Hayles, now 25 and an assistant manager at a hotel
in Banff, Alberta, tried several of those
treatments, to no avail.
Fed up, she turned to the Internet and was surprised to find
a group of people with hyperhidrosis who offered support and
encouragement and who informed her about newer treatments.
One such therapy is endoscopic transthoracic sympathectomy,
a surgical procedure that interrupts transmission to nerves
in the chest that power the sweat glands in the armpits,
palms and soles. In the surgery, a video camera and
surgical instruments are inserted in the chest through
small incisions. Then the surgeon clamps, cuts or
cauterizes the nerves.
The operation, also used to treat severe blushing, can have
side effects. Some patients develop air leaks in the lung, a
complication that requires the temporary insertion of a
chest tube.
Rarely, patients can suffer nerve damage and develop
Horner's syndrome, a disorder characterized by drooping of
eyelids and constriction of pupils.
A dreaded and puzzling side effect of the surgery is
compensatory sweating in other parts of the body, most
typically the back, torso and inner thighs.
Studies suggest that compensatory sweating may occur in as
much as 85 percent of patients who undergo transthoracic
sympathectomy.
In a study led by Dr. Neelan Doolabh, a surgeon in private
practice in Tyler, Tex., 88 percent of the patients who
developed compensatory sweating rated it as mild, and 10
percent of the patients rated it as moderate.
Mv. Doolabh said that in his experience patients were
generally thrilled with the surgery.
"People wake up, and they are dry," he said. "The results
are immediate, and they can go home the same day."
Mw. Hayles and Ms. Behrens chose to have the operation. Ms.
Behrens was delighted with the results and experienced
no bad effects. Her hands no longer sweat at all, she
said, and her underarms and feet sweat just a bit.
Mx. Hayles was less fortunate. She no longer had sweaty
hands, but she soon began to sweat profusely on her
back, a problem that has worsened. She is considering a
second operation to reverse the first surgery, but few
surgeons perform the procedure, and the results are
uncertain.
Botox, the newest treatment for hyperhidrosis, is less
drastic. This year, the Food and Drug Administration is
highly likely to approve the drug as a treatment. Many
doctors already use it.
A recent study comparing Botox with a placebo found that it
was nearly three times as effective in decreasing sweating.
The procedure is simple, said Dr. Victor Neel, director of
dermatologic surgery at Massachusetts General Hospital in
Boston, who treats mostly armpit, or axillary,
hyperhidrosis.
"Patients receive about 15 injections per axilla with a
small needle,"
My. Neel said. "The whole thing takes about 15 minutes."
Axillary injections, Dr. Neel said, last six to nine months,
and injections for the palms or soles, four to six months.
The side effects include pain, which can be treated with
topical anesthetics beforehand, and muscle weakness, which
usually subsides on its own.
The major drawback to Botox, experts say, is cost.
Injecting both armpits can cost several thousand dollars a
year, and patients often have to pay out of pocket.
Nevertheless, Botox and other treatments have given some
patients new freedom.
Mz. Behrens says she now has a management job where she
shakes hands every day.
"I would never have been able to do that before," she said.