What is hyperhidrosis?
Hyperhidrosis is a medical term for excessive sweating. Excessive sweating is defined as sweating that goes beyond what is necessary to cool the body. It is very common, affecting 2.5 to 3% of the population. Hyperhidrosis can be focal (common) or generalized (rare). Focal hyperhidrosis affects certain areas of the body in any combination: face, underarms, palms, groin, and soles. Its cause is unknown. Generalized hyperhidrosis is usually associated with an underlying disease that needs to be diagnosed and treated. See your doctor. Only the treatment of focal hyperhidrosis is discussed here.
What is the significance of hyperhidrosis?
Hyperhidrosis is not a dangerous condition. Its significance is social. If you suffer from this condition, you don’t need to be told about its impact on your life. It is embarrassing. You need to constantly wipe your hands and face. You dread having to shake hands. You cannot grip objects firmly. You avoid social situations. You only wear dark-colored clothing to hide the wetness in your underarms. Your cleaning bills are huge. You have to buy new shirts, blouses, jackets, socks, and shoes more often. And on and on. The disorder is debilitating, and the overall effect on your life cannot be overstated.
What are the current treatments for hyperhidrosis?
The most common ways to treat hyperhidrosis are:
Focal Nerve Blocking injections: blocking the signal from the nerve to the sweat glands. This is the therapy offered by MedAesthetics.
RF Ablation of Sweat Glands: Permanently destroying the sweat glands by ablation using Microneedling with Radio Frequency. This therapy is also offered by MedAesthetics.
Topical treatments: applying aluminum chloride hexahydrate 20-25%. This is effective for mild to moderate sweating.
Oral medications: can be aimed at the underlying conditions. There are no specific drugs available for hyperhidrosis. Nerves can be inhibited by oral medications, but these drugs usually cause excessive drowsiness. They are not practical and not recommended.
Iontophoresis: applying low-intensity electric current to affected areas while they are immersed in an electrolyte solution. It can be useful for palms and soles, but is obviously impractical for face and underarms. It needs to be repeated regularly.
Surgery: a) Excision of the sweat glands in the underarms can be done, but this is not very popular. Scarring can be severe. b) Sympathectomy: surgery to cut the nerves that feed the sweat glands can work very well for the face and palms. It is less predictable for the underarms, and completely impractical for the groin and soles, because it requires open abdominal surgery (Sympathectomy for the upper body is done using scopes inserted through small incisions in the chest).
How does nerve blocking work for hyperhidrosis?
Injecting a nerve blocking agent (Therapeutic Botox) interferes with the transmission of signals from nerves to sweat glands. Without nerve impulses to tell the glands to make sweat, the gland dries up.
What nerve blocking agent is used?
The substance injected is a nerve blocking agent, botulinum toxin type A. There are currently three nerve blockers available in Canada. We use the one which is the most common, has been around the longest, and has hundreds of scientific studies.
What areas can be treated with nerve blockers?
The most common areas treated are the underarms, palms, and soles.
Who is a good candidate for nerve blocking treatments of hyperhidrosis?
Almost anyone who does not respond to simple measures to counter sweating is a candidate. Only people with preexisting nerve and muscle disorders such as myaesthenia gravis, Eaton-Lambert syndrome, and amyotrophic lateral sclerosis cannot use nerve blockers.
How are treatments done?
At each site where you want your sweat reduced, several tiny injections are placed into the skin using a very short very fine needle. Underarm treatments take about 20-30 minutes. Treatments of palms or soles take about 40-60 minutes.
Can all affected areas be treated at once?
We limit the amount of nerve blocker injected per session to 200 units to minimize the possibility of side effects such as nauasea. If you are doing more than one area (eg. underarms and palms) each area must be done at a different session, usually one to two weeks apart. This is a very conservative approach taken to ensure your safety. In experienced patients we have used twice this dose in a single session without difficulties.
What is the cost of nerve blocking treatments for hyperhidrosis?
The fee for injections is $200 per session. The cost of the injected medication is about $407 for 100 units. Many insurance companies cover the cost of the medication.
Do insurance companies cover the cost?
The cost of the medication itself is frequently covered by your extended health insurance. The injection fee is not usually covered. You should check with your insurer. We provide a receipt and a letter for you to send to your insurance company. We do not bill your insurer directly. You need to submit a claim for reimbusement of the payment you make to us at the time of service.
Is hyperhidrosis therapy eligible for Health Spending Accounts or tax credits?
Most health spending accounts allow you to use the funds for any service performed by a physician. Since the clinic is owned and operated by a physician, hyperhidrosis treatments qualify for payment through health spending accounts. Check with your human resources department to make sure. As of March 2010, medical services that are purely for cosmetic purposes ceased to qualify for the medical tax credit.
Do these treatments hurt?
When done properly, nerve blocking injections for the underarms are very well tolerated. Palms and feet are quite tender and prone to reflex jerks, so we recommend pretreatment with topical anesthetics. Numbing cream must be applied about one hour prior to treatment. Despite this numbing, treatment of palms and soles is still uncomfortable. We also use cold air or ice during treatment to help.
How long does it take to see results and how long will it last?
It takes 2 to 7 days before results are noticeable. The effect lasts six to seven months on average with some people experiencing results up to one year.
What are the side effects?
Bruising is fairly common (10 to 20%). Rarely, the medication spreads too far, and weakness of the muscles occurs. This effect is usually mild and lasts a few weeks. It is not relevant to underarm treatments, but it might have a noticeable effect in the hands, which are full of small muscles. The medication can aggravate nerve and muscle disorders, so it cannot be used in rare disease states such as myaesthenia gravis, Eaton-Lambert syndrome, and amyotrophic lateral sclerosis. Occasionally, headaches, nausea, and flu-like aches occur. They usually resolve within 24 hours.