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Excessive Sweating/Perspiration, Hyperhidrosis

Quick Facts

• Hyperhidrosis is defined as sweating in excess of the normal needs of the body
• There can be underlying medical problems causing this in some cases, and it needs to be investigated by a doctor
• There are a number of treatments for hyperhidrosis
  • Aluminium chloride (topical medication)
  • Iontophoresis -  regular treatments, placing affected area in electrically charged water/sodium glycopyrrolate
  • Medication - suited to those who sweat in several areas
  • Anti-wrinkle injections - injections used normally for facial wrinkles can be injected in areas such as the underarms/hands/feet. The average duration of effect is 8 months
  • Endoscopic thoracic sympathectomy (surgery) - but this can have the effect of compensatory sweating elsewhere after the surgery is performed.

What is hyperhidrosis?

It is classified as either primary or secondary hyperhidrosis. Primary hyperhidrosis is not due to any particular underlying reason, and can result in excessive sweating in the palms, feet, underarms, face and scalp. There is usually an associated family history. Sweating usually affects both sides, and is less at night than during the day. Secondary hyperhidrosis is a result of an underlying medical condition such as infection, endocrine disorders, metabolic disorders, neoplastic diseases, neurological conditions, spinal cord injuries, cardiovascular disorders, respiratory disorders, anxiety and stress. The treatment of secondary hyperhidrosis will require treatment of the underlying problem or cause.

The rates of primary hyperhidrosis are estimated at 3% of the population, the age group most affected is from 18 to 54 years.

How can hyperhidrosis be treated?

Anti-perspirants are usually the first line of treatment for underarm and palm sweating, but are not as useful in other areas.  Driclor, a brand of aluminium chloride, blocks sweat glands and eventually destroys them.  It is usually applied at night and washed off in the morning. In the long term, it can be used less frequently as sweating decreases. Irritation is a common side effect, and may often require the use of hydrocortisone 1% to reduce this. Driclor is available over the counter.

Anti-wrinkle injections, normally used to help reduce the wrinkles on the face can also work to stop sweating. Anti-wrinkle injections have been widely used for the treatment of hyperhidrosis, especially in the underarms, face and scalp. It can also be used in the palms and feet, but is very painful to inject in this area and may require some form of sedation/anaesthetic . The underarms/scalp don't tend to be too painful and can often be done with just local anaesthetic cream. Anti-wrinkle injections work by stopping the nerve signal to the sweat glands in the area it is injected into.  The underarms are the most common area treated by anti-wrinkle injections. Usually 100 units are used for this area, and the cost of this treatment is $1320. For feet and hands, 100-200 units are required to do both the right and left sides, and the price of this is $1320 to $2220. Alternately, only the right hand or dominant hand can be treated and with 50 to 100 units and the price of this is $790 to $1320.

After application of anaesthetic cream, Minor's starch-iodine test is performed. This involves putting iodine on the area to be treated and allowing the area to sweat for a while. Starch is placed on the area and the sweaty areas highlight in black. These areas are then treated with the injections.

Figure: Minor's starch-iodine test

The hands can also be treated, and often only the dominant hand is treated (to avoid a wet hand shake). The dosage is variable in the hands, but usually requires around 50-100 units per hand. The face or scalp can be treated for excessive sweating with anti-wrinkle injections. There is the possibility that it will affect the muscles of facial expression also, and this may lead to unwanted changes in the muscles. The dosage for the face/scalp will depend on the size of the area treated. Feet are very difficult to treat with, anti-wrinkle injections and can often be unresponsive to even larger doses. The main difficulty with the treatment of feet with anti-wrinkle injections is the sensitivity of this area to injections and sedation may be required to do the procedure. This treatment is commonly performed at The Victorian Cosmetic Institute by our doctors. 

Facial sweating can also be treated. Anti-wrinkle injections can be used in some areas, but because they also relax the muscles of facial expression, they cannot be used in all areas as they may affect one's ability to express normally. They are effective for areas such as the upper lip and forehead in particular, and may have the added benefit here of reducing wrinkles in these areas if present. Alternately, topical agents can be used for facial sweating. We commonly recommend topical glycopyrrolate gel, which usually lasts for about 3 days with each application. 

Endoscopic thoracic sympathectomy is usually the final step in improving hyperhidrosis. By surgically disrupting the nerves that cause sweating (the sympathetic nervous system), this procedure is able to reduce sweating in the upper limbs, feet, or underarms. This part of the nervous system is also responsible for other functions such as the size of the pupil, opening the eyelids, hence this surgery can also disrupt these functions. Furthermore, compensatory sweating may occur in the areas that have not been treated. This treatment is not performed at The Victorian Cosmetic Institute.

How much are hyperhidrosis treatments?

Hyperhidrosis treatment prices are as follow;

Treatment of hyperhidrosis with 'anti-wrinkle' injections 

Why should I choose The Victorian Cosmetic Institute as my provider of hyperhidrosis treatment? 

Making that first phone call can be a confronting task - many of our patients have preferred filling out our online enquiry form. We can then contact you with an understanding of the results you are hopeful of achieving and ensure the treatment is appropriate.

Otherwise, you can phone us directly on (03) 8850 0655 (Templestowe) or (03) 9707 0888 (Berwick).