Hyperhidrosis, goodbye to excessive sweating with Neoderma
Hyperhidrosis (excessive sweating), is a disorder caused by an alteration of the vegetative nervous system that produces more sweat than necessary to regulate the temperature of our body. This problem, which affects a significant percentage of the population and men and women equally, induces insecurity, lack of confidence, anxiety and stress, and in most cases affects the quality of life of those who suffers it, interfering in the natural development of daily activities.
There are several degrees and the causes of excessive sweating are varied. For those affected, trying to normalize the situation is a priority that is pursued with an increasingly pronounced interest.
The causes for the apparition of this disorder are diverse and they are usually manifested in localized areas such as armpits, palms of the hands, soles of the feet and forehead.
To eliminate excess sweat, in NEODERMA CENTRO MÉDICO we recommend botulinum toxin type A, as the only non-surgical alternative that manages to interrupt sweat glands hyperactivity with a high degree of effectiveness. The product is infiltrated in the affected area through an extremely fine needle that blocks the sympathetic nerve endings responsible for the stimulation of the sweat glands.
The botulinum toxin is known for its effectiveness in hiding wrinkles and lines of expression, and it has been used for over 10 years to combat excessive sweating problems with very effective results. It is a fast, effective and painless technique performed in the doctor's office on an outpatient basis. Treatment in the armpit area does not require anaesthesia and with a few infiltrations we can considerably reduce sweating in this area. This treatment does not require time off work –it is performed in a short time and the patient can return to his or her normal routine once completed.
The results are gradually shown within a few days of the application of botulinum toxin and the effects can last for between four months and a year, depending on the area and the particular characteristics of each patient. For example, the effects of the axillary hyperhidrosis treatment last an average of 7 months. It is recommended a yearly maintenance –although in some patients there is the possibility of the definitive elimination of excessive sweating with just a few sessions.
Palmar and Axillary Hyperhidrosis
Focal primary hyperhidrosis may present itself in palmar, plantar, axillary and craniofacial areas. Mild cases can be fought with classical medical treatments, but moderate and severe intensity hyperhidrosis are resistant to them and have a negative impact on the patients’ quality of life. The bilateral transthoracic sympathectomy surgical treatment can resolve a large number of these cases with few side effects, although many patients do not want to undergo the surgery with general anaesthesia.
For a few years now botulin toxin type A has been used as a safe and effective treatment alternative when injected in focal primary hyperhidrosis –palmoplantar and axillary– areas.
Botulinum toxin action mechanism in hyperhidrosis
It blocks the acetylcholine binding in the cholinergic fibers of the eccrine sweat glands causing their chemical denervation.
Commercial botulinum toxin type A (BTX-A)
There are two commercial BTX-A preparations available in Spain: Botox® (Allergan Pharmaceuticals, Irving, California, United States) and Dysport® (Ipsen Products, Maidenhead, Berkshire, Great Britain).
The Botox® vial contains 100 U of BTX-A and the one of Dysport® contains 500 U, taking into account that 1 U of Botox® is equivalent to approximately 4 U of Dysport®
Method of application on palms
1.- Examination of patients for evaluation, hyperhidrosis identification, information and signing of the informed consent.
2.- Delimitation of the hyperhidrotic area using the Minor starch-iodine test: dry the palm, apply the iodine solution, dry, apply wheat starch powder, wait for the patient to sweat again. The hyperhidrotic area will be stained dark blue.
3.- Regional anaesthesia at wrist level with three points for median, ulnar and radial nerve block with 1% lidocaine or 2% mepivacaine.
4.- Marking of injection points: equidistant points are marked at 1.5 cm. throughout the hyperhidrotic zone of the palm.
5.- Injection of BTX-A: mixture of Botox® with 4 cm of a saline solution to obtain a 2.5 U / 0.1ml concentration and injecting 2.5 U at each point with a 30G needle bevel going upwards and deep intradermal to a total of about 100 U / palm with half a dose in thenar eminence to avoid functional impairment of the pinch grip movement.
6.- The first post-treatment check-up is done after one month. The effectiveness is objectively evaluated with the starch-iodine test and the substance is reinjected if necessary.
Sweat reduction begins between the 3rd and 7th day after the treatment and stays for an average of 4 to 6 months. Slight loss of hand strength –especially the pinch grip– may appear as a side effect, but it will get better within 2 to 8 weeks.
Method of application in the soles of the feet
The process is similar to the one of the palms, but taking into account that the starch-iodine test usually delimits the hyperhidrotic area in a “moccasin shape”. Regional anaesthesia is applied in the posterior and sural nerves. It is injected up to 100-150 U of Botox®, 2.5 U per point.
Method of application in the armpit
Once the patient has been examined and having the armpit shaved, the hyperhidrotic area is delimited with the starch-iodine test, where injection points are marked at 1.5 cm and 2 U / point up to a total of 50 U of Botox® are injected. It doesn’t require anaesthesia, although cryoanesthesia can be used in more sensitive persons. In the follow-up session after a month of the treatment, the starch-iodine test is used to determine the level of sweat reduction and another dose is injected if it necessary.
Armpit application does not have any side effects and the satisfaction of the patient is usually high. The treatment effect lasts for 7 months in average and with successive applications effects are normally prolonged.
Contraindications in the hyperhidrosis treatments
BTX-A must not be injected in none of the abovementioned treatments if pregnant or lactating, if aminoglycosides are being taken and if there are neuromuscular diseases or hypersensitivity to any of the components of the product.