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  Cosmetic Surgery & Aesthetic Procedures

June 2011
Stop Sweat With Botox
Dr Kuldeep Singh
 
Excessive sweating of the underarms is called axillary hyperhidrosis. Although neurologic, metabolic and othersystemic diseases can sometimes cause excessive sweating, most cases occur in people who are otherwise healthy(primary hyperhidrosis).

Heat and emotions may trigger hyperhidrosis in some, but many who suffer from hyperhidrosis sweat nearly all the time, regardless of their mood or the weather.

Treatment
Over-the-counter antiperspirants:
Home remedies like these are usually tried first because they are readily available. Antiperspirants containing aluminum chloride (for example: by Dove or Oriflame) may be more effective when other antiperspirants have failed. So-called "natural"antiperspirants are often not very helpful.

Prescription-strength antiperspirants:
These are the ones containing aluminum chloride hexahydrate.

Iontophoresis:
A device that passes direct electricity through the skin using tap water – difficult to use.

Oral medications:
From the group of medications known as anticholinergics, which reduce sweating – have uncomfortable adverse effects.


Botox (botulinum toxin):
Has been approved in the U.S. by the FDA for treating excessive axillary (underarm) sweating.

Surgery:
Cervical sympathectomy (ETS), as a last resort.


Role of Botox

Most of those who suffer from the problem of excessive underarm sweating would swear that conventional remedies like antiperspirants and oral medication or even surgery have no long-term impact on their condition and they would probably be right.

A big advantage of Botox is that it provides relief from excessive underarm  sweating for at least six months and even up to 10 months in some cases. In the  treatment of primary axillary hyperhidrosis, about 50 units of Botox is injected into about 25 points into the skin of the underarm of the patient to prevent the release of a chemical called acetylcholine, which carries signals from the sympathetic nervous system to the sweat glands in the underarm, to stimulate sweat production.

The injection of Botox simply blocks the nerves in the underarm that cause excessive sweating and thereby prevents sweating in that area.

As part of the trial phase prior to its gaining approval from the FDA, 322 patients afflicted by axillary hyperhidrosis were injected with Botox. Of those, 81% reported more than a 50% reduction in sweating. And 50% of the patients reported an alleviation of excessive underarm sweating for nearly seven months. So, excessive sweating is effectively reduced to comfortable levels.

The Procedure
When used to treat axillary hyperhidrosis, Botox injections should necessarily be administered by a specially trained physician who is familiar with the procedure.
Typically, Botox injections are administered using a very thin needle (30G) under the skin near the sweat glands in the underarms. A starch Iodine test is done prior to the injection to map out areas of excessive sweating so as to not miss areas. Sometimes, in sensitive patients, a topical anesthetic cream (prilox, emla) can be applied 45 minutes in advance to reduce the injection prick sensation.

A patient will sometimes continue to experience sweating in the edges of the affected area if the initial injections missed a few sweat glands. In that case, a top-up dose of additional injections may be required. In any event, the procedure is virtually painless, requires very little time and is conducted at the physician’s office itself.

Price:

Generally a dosage of 50 to 100 units is administered to the armpits. The injection is priced at Rs 25,000 per 100 units. Though the effect lasts for only six months, people who want to get a botox shot to stop sweating in the armpits would get it done every summer when there’s excess sweating.

The Flip Side
  • The symptoms of axillary hyperhidrosis will return after 6-10 months and the patient has to go in to the physician’s office for a repeat dose of Botox. Botox treatment by itself causes no permanent damage to an individual’s system and a patient can go in for as many doses as required, provided the intervals between the doses is strictly regulated.
  • There have also been recorded instances of patients reporting compensatory sweating (perspiration in areas other than the one injected)
  • Some people have also reported localized pain or mild bruising at the place where the injection is administered. However, these symptoms are usually reversible.
  • Very rarely, adverse effects like influenza-like symptoms such as fever, inflammation of the throat and headache may be seen.
Botox is not recommended for the treatment of pregnant or breastfeeding women and those who are allergic to Botox. Additionally, sufferers of secondary axillary hyperhidrosis who have other neurological disorders do not qualify for Botox treatment. For this reason it is always necessary for a patient to undergo a detailed physical examination before the Botox injection is administered.

Insurance cover
Because axillary hyperhidrosis is a medical condition, a patient is eligible to insurance coverage and reimbursement for physician’s fees and treatment.

Dr Kuldeep Singh is Senior Consultant, Plastic Surgeon Apollo Indraprastha Hospitals New Delhi.


    
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