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EXCESSIVE SWEATING-PRIMARY HYPERHIDROSIS
Focal hyperhidrosis is a common condition associated with excessive sweating usually involving the palms, underarms, face, or feet. There is considerable emotional and social stigma attached to this condition. Patients afflicted with the disorder can routinely soak through clothing in a matter of minutes, and resort to pads, shields, absorbent tissues, and frequent changes of clothing to cope with the disorder. Patients typically wear jeans in order to frequency wipe their hands without leaving visibly soaked areas. Clothing is quickly stained and ruined, and thousands of dollars can be spent on dry cleaning and replacement of clothing. Traditional therapies have included topical aluminum salts used in antiperspirants or oral medication such as Robinul. More drastic approaches include surgical excision of the axillary skin followed by grafting, or sympathectomy for hyperhidrosis of the palms. Most of these therapies either have only minimal effects or are associated with both side effects such as blurred vision or dry mouth and complications such as unsightly scarring or nerve injury with limitation of mobility.
ROLE OF BOTOX IN PRIMARY HYPERHIDROSIS
Intracutaneous injection of botulinum toxin is highly effective in abolishing focal hyperhidrosis. Sweat producing glands are innervated by cholinergic sympathetic nerve fibers. Botulinum Toxin prevents the presynaptic release of acetylcholine in these nerve endings. When these nerve endings are blocked, sweating is dramatically decreased.
According to studies, the optimal effect of Botox or Myobloc can last anywhere from 4 months to 12 months. Treatment will need to be repeated every 5-8 months on average. In some cases a second treatment may be required to block a maximum amount of nerve endings supplying the sweat glands. Botulinum Toxin is a safe and simple treatment for many patients with focal hyperhidrosis. The procedure is relatively painless and Dr. Jagodowicz uses numbing procedures in conjunction with treatment of sweating of the hands and feet. Botox carries the potential to replace current invasive surgical procedures. The drug is FDA approved for axillary hyperhidrosis.
CASE STUDY: PATIENT: WB*
“I can sweat 24/7 and be in any situation-whether it just be hanging out with friends or being at work. I remember ruing a purple bride’s maid dress in a wedding because I was sweating so profusely-my underarms were actually stained purple”
This patient is a 31 year old female who works as an assistant principal. Her early memories of severe axillary sweating are when she was 6 or 7 years old. She saw about 3 or 4 different family doctors but none of them told her the name of the condition. She was finally diagnosed with severe primary axillary hyperhidrosis in college. The patient failed on prescription antiperspirant and laser formaldehyde. She started Botox treatments in 2004 and has been extremely satisfied with the results.
* Individual results may vary.