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Excessive Sweating (Hyperhidrosis)

Do you experience underarm sweating resulting in stains on your favorite blouses?  Do you avoid public speaking knowing that you’ll be dripping wet?  Are you embarrassed by a sweaty palm print on your school papers?  Do you avoid shaking hands?  We can help!

There are 2 main categories of excessive sweating that have different treatment approaches.  One is excessive sweating under the arms, or axillary hyperhidrosis.  Women Physicians offers in-office highly effective treatment for axillary hyperhidrosis. 

The other is excessive sweating of the palms and/or feet, or palmoplantar hyperhidrosis.  Follow the links for information on each.  


Underarm or Axillary Hyperhidrosis

Questions and Answers

Why is underarm sweating a problem?

Some people experience excessive underarm sweating called hyperhidrosis.  This excess can lead to embarrassment and stains on clothing.  It causes some people to avoid public speaking and to limit their wardrobes.  Many women worry about it during special occasions like weddings, interviews, or travel. 

How does Botox® work?                                                                                      

Botox® works by blocking the nerves that stimulate the sweat glands under the arms.  It can reduce 90% of the sweat produced by these glands.  It does not cause muscle weakness when injected under the arms.

How is it injected?  

It is injected with a tiny needle just underneath the skin, similar to how a TB test would be injected.  Multiple injections are required at spaced intervals to fully cover the whole surface that is responsible for sweating.  We locate the active sweat glands with a protocol that uses iodine and cornstarch so expect the procedure to be a little messy.  It takes from 30 minutes to an hour.   

How long does it last?

Typically, the results take effect within 2 weeks.  The treatment will continue to provide underarm dryness for 6 months to 16 months depending on the individual. 

What side effects can be expected?

You may feel stinging at the time the injections are administered.  Temporary bruising could occur within the next few days. 

Are there people who should NOT have these injection?

You should not have Botox® if you have a neuromuscular disorder, are pregnant or breastfeeding, or take certain medications such as aminoglycosides or cyclosporine.  If you are allergic to iodine, the standard procedure will need to be altered and decreased effectiveness is possible. 




Excessive Sweating of the Hands and Feet

What is the recommended treatment?

Iontophoresis uses a simple device to treat excessive sweating of the hands (palmar hyperhidrosis) and feet (plantar hyperhidrosis). It is particularly useful for people who've tried prescription-strength antiperspirants but find that they need a stronger treatment. Used correctly and adjusted to individual situations, iontophoresis has proven to have a very high success rate (83% according to the American Academy of Dermatology) for people with sweaty palms and sweaty feet.

How does iontophoresis work?

Iontophoresis uses water to conduct a mild electrical current through the skin's surface. It's not entirely understood how or why iontophoresis works, but it's believed that the electric current and mineral particles in the water work together to microscopically thicken the outer layer of the skin, which blocks the flow of sweat to the skin's surface. Once this sweat output is blocked or interrupted, sweat production on the palms and soles is, often suddenly and dramatically, "turned off."

What is the process of iontophoresis?

During iontophoresis patients sit with hands or feet, or both, immersed in shallow trays filled with water for a short period of time (20 to 40 minutes) while the device sends a mild electrical current through the water. The process is repeated every other day for five to ten days or until sweating is reduced to a comfortable level. Once the desired dryness has been achieved, patients are switched to a maintenance schedule, ranging from once per week to once every four weeks, depending on the individual. To maintain dryness, iontophoresis must be repeated as soon as sweating begins to return.

What if it doesn't work?

Sometimes, tap water in certain geographic locations may be too soft for iontophoresis to work. That is, it doesn't contain many minerals or electrolytes (tiny particles that help the electric current travel through the water and into the skin). Adding about a teaspoon of baking soda to the trays of water will take care of this.

If iontophoresis with plain tap water or tap water with baking soda doesn't produce the desired dryness, a prescription medicine called an anticholinergic may be added to the water. In the majority of cases this works and causes the palms and soles of the feet to stop sweating.

Who should NOT do iontophoresis?

Women who are pregnant, people with pacemakers, or substantial metal implants (such as joint replacements), cardiac conditions, or epilepsy should not use iontophoresis. All jewelry should be removed before iontophoresis. If excessive dryness of the skin occurs, moisturizers are recommended. Skin abrasions, cuts, and hang nails should be covered with Vaseline or a similar barrier before iontophoresis to prevent skin irritation. If the skin along the "water line" becomes irritated due to iontophoresis, Vaseline should be applied to that area before each treatment. To relieve skin irritation that has already occurred, a simple 1% hydrocortisone cream is recommended. Patients are often concerned about getting an electric shock during iontophoresis but the current used is not strong enough to cause harm. It can startle you, however, so your doctor will teach you how to avoid such shocks. Iontophoresis is not usually recommended for excessive underarm sweating (axillary hyperhidrosis) because the skin in the armpits is likely to be irritated by the process and because it is prohibitively difficult to perform iontophoresis on the underarms.

How do I get started?

Successful iontophoresis requires a learned technique so it's very important that you see a physician to learn the correct usage of iontophoresis.  After 6 treatments to make sure you tolerate it and that it works for you, you can get a prescription for a home-use iontophoresis machine. In the United States experts recommend the iontophoresis machine available through R.A. Fischer Company. This machine costs about $615.00 (Other, less expensive, over-the-counter devices have been found to yield unsatisfactory results.) A $25 discount is available for SweatHelp.org visitors. Patients in the U.K. are advised to look into machines made by STD Pharmaceutical.