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Botox for Hyperhidrosis
Treatment - Secondary hyperhidrosis is treated by first addressing the underlying disorder. If a patient is on hormonal therapy then administration of an anti estrogen (ciproterone acetate) can give relief to sweat attacks. Primary hyperhidrosis patients and secondary hyperhidrosis patients experiencing moderate to severe sweating not relieved otherwise may benefit from the following treatment modalities; Antiperspirants (Drysol), Iontophoresis. Medications (anti-cholinergics), Surgery.
Antiperspirants - The first therapeutic measure recommended. Aluminum Chloride Hexahydrate (20-25%) in 70-90% alcohol applied in the evening 2-3 times per week. Less effective over time (within months). High incidence of skin irritation. 10% Glutaraldehyde. Good clinical result in 72 hours. Brown discoloration of the skin occurs. Effective in individuals with light to moderate hyperhidrosis, but not always. Must be repeated regularly for life.
Iontophoresis - Tried, if antiperspirants not effective.
Used to treat palmar, axillary, and plantar hyperhidrosis.
Medications - No specific medication to treat hyperhidrosis. Sedative (psychotropic) and/or anti-cholinergic drugs commonly used. Many side-effects. Dry mouth "cotton tongue". Accomodation difficulties of the eyes (hard to focus eyes). Many others. Not generally recommended for treating hyperhidrosis. Low dose anti-cholinergic agents may decrease excess sweating without causing incapacitating side-effects in those few individuals who suffer only from profuse truncal sweating. A dosage necessary to normalize the amount of sweating is rarely tolerated.
Surgery - Endoscopic Sympathectomy, Treatment of Choice for Severe Hyperhidrosis. Interruption of nerve impulses to sweat glands of the palms, face, axillae (armpits) by cutting or electrocautery is called "Thoracic Sympathectomy". The ganglia (nerve junctions) which lead to the sweat glands of the palms, axillae, scalp and face are accessible through the chest (thoracic cavity) because they travel along the side of the spine of the back. Using a Micro Single Incision endoscopic technique, easy access to this area requires only a single 1/12th inch incision per side. In the past, a rib was removed or a large painful incision was required between two ribs to provide access to this area. Some surgeons today make three to four small incisions when performing endoscopic thoracic sympathectomy. Dr. Nielson has applied state-of-the-art technology to his endoscopic technique and he only makes a 1/12th inch incision per side.
Excessive sweating of the whole body and/or trunk cannot be treated surgically.
Botulinus toxin (Botox injections) - Produced by a bacteria known as Clostridium botulinum, this toxin is one of the most lethal poisons known. This toxin interfers with the neurotransmitter acethylcholine at the synapses (nerve junction points). Progressive paralysis of all muscles in the body develops. Botulinus toxin given in extremely low doses has been used to treat localized muscle hyperactivity such as lid spasms and torticollis. Side effects include: dry mouth, bladder paralysis, bowel inactivity, and others. Repeat injections are frequently required every 1 to 6 months.
Hypnosis - Individuals who have tried hypnosis for palmar hyperhidrosis have reported little improvement.
Lasertherapy - Some desperate patients have tried this technique. This technique involves direct irradiation of the palms which results in 3rd degree burns of the hands without any improvement in sweating.
Radiotherapy - High-dose radiation to treat axillary hyperhidrosis. Serious dermatitis and skin retraction develops.
Psychotherapy - Limited effect in the majority of patients. Psychological problems commonly develop as a consequence of hyperhidrosis, not the other way around. Psychiatric or psychopharmacologic therapy may help an individual to cope with hyperhidrosis condition, but certainly won't treat the disorder.
Alternative Treatment Methods - Alternative Medicine, Homoeopathy, Massage, Acupuncture, Phytotherapeutic (Herbal) drugs. These methods are hard to document improvement.
Axillary Sweat Gland Removal - Z-plasty excision of the axillary sweat glands. Hypertrophic and/or constrictive scars may sometimes form restricting shoulder motion.
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