4 days Ago
Question: My 15-year-old daughter is really embarrassed by excessive sweating. The affected areas seem to be just her hands and feet, which she’s very self-conscious about when hanging out with friends and playing sports. She showers and washes her hands regularly.
I know you can get botox for sweating but is she too young for this? What else can we do? Dr Grant replies: Excessive sweating from areas on the body where sweat glands occur is known as hyperhidrosis and is thought that about 1pc of the population suffer moderate to severe forms. It can cause significant psychosocial distress but rarely has an underlying medical condition to explain the sweating episodes. It is called focal hyperhidrosis when it affects the armpits, palms of the hand, soles of the feet or less commonly the face, scalp, groin region or under the breasts.
It commonly begins in childhood or adolescence and tends to run a chronic lifelong course but in a few people symptoms can resolve spontaneously over time. Classic features include age of onset typically under 25 years old, often with a family history, affecting both sides of the body equally (e.g.
both hands) and symptoms do not occur at night. Read more Generalised hyperhidrosis affects the whole body and can occur both during the day and at night. This form of the condition is rarer and can have underlying medical explanations such as chronic infection, thyroid/endocrine and other disorders need be ruled out.
Most people presenting to a doctor will have hormone blood tests checked prior to management. There are only a few proven treatment options for hyperhidrosis, the first line one being topical aluminium chloride-containing anti-perspirant deodorants. These are safe to use regularly for life and effective for milder forms of hyperhidrosis, but obviously cannot be applied to the face or scalp.
Iontophoresis can be used on the hands or feet and involves immersing them in warm water (or a wet contact pad) through which a weak electric current is passed. Botulinum toxin ‘Botox’ injections, delivered by multiple intra-dermal injections to the sites involved, are used to treat focal hyperhidrosis and can take three to seven days for full effects that can last three to nine months. Botox works by binding to the nerve endings and preventing the action of acetylcholine, a chemical that stimulates the sweat glands, thereby inhibiting sweat production.
Even though she is only 15 years old, a medical doctor could still try this treatment safely and effectively. Microwave thermolysis or ‘miraDry’ is a non-invasive US FDA (United States Federal Drug Administration) approved laser therapy that uses electromagnetic energy to destroy the sweat glands. Typically two treatments are required about three months apart with usually permanent results.
However, some people find one treatment provides an adequate reduction in sweat. It is worth noting that miraDry can only be used to treat underarm sweating and is not suitable for the hands, feet or groin area. Lastly, Endoscopic Thoracic Sympathectomy (ETS) is another permanent but surgical procedure to cut the sympathetic nerve supply (that promotes sweating) to the sweat glands in the upper limb.
There are a few rare but potentially serious complications and for this reason sympathectomy is generally reserved for patients who have a BMI <28, absence of symptoms at night and no significant underlying medical conditions. Up to 50pc of patients can suffer subsequent and persistent ‘compensatory hyperhidrosis’ elsewhere after undergoing ETS. A few lifestyle modifications to consider in patients who suffer with hyperhidrosis include weight loss (if overweight), showering twice per day and wearing loose fitting (ideally cotton) clothes which can help reduce sweating.
Also consider reducing or avoiding caffeine, nicotine and alcohol, as this will also help. Dr Jennifer Grant is a GP with Beacon HealthCheck Read more.
