| Hyperhidrosis,
or excessive sweating, is a relatively common condition which potentially
interferes with personal and professional life. Focal hyperhidrosis commonly
affects the underarms (axilla) or palms. Medications are not usually very
effective for this condition and until recently only surgery could be offered.
Surgery involved removing a group of nerve cells located near the first
rib called the superior cervical ganglion. This surgery can have significant
side effects. More recently, it has been recognized that botulinum toxin
can easily and effectively treat this common condition.
At Bellaire Neurology, Dr. Loftus treats primary axillary hyperhidrosis,
forehead, and palmar hyperhidrosis with botulinum toxin type A and B.
Botulinum toxin inactivates acetylcholine nerve endings. The axillary
area (underarm) contains mostly eccrine sweat glands that generate most
of the sweat. These glands are innervated by acetylcholine nerve fibers.
The injection itself is mildly uncomfortable in the axilla but moderately
uncomfortable in the hand. Topical anesthetics can be used to reduce
the
pain. It is rare to get any systemic side effects except that botulinum
toxin type B commonly causes a mild dry mouth.
The best dosing for this procedure is not entirely clear. A recent study
published in the April 2002 Journal of American Academy Dermatology suggested
that high dose Botox - 200 units per axilla produced a longer period of
time between treatments. In their study, 1 in 8 relapsed within one year,
with 2 out of 3 lasting more than 19 months. The longest effect was seen
in one patient who had been followed for 29 months. In contrast, studies
with 50 units per axilla varied from 100% relapse after 7 months to a
high percentage going beyond 8 months but not one year. In general, the
treatment is priced per unit and therefore it appears to me that the most
cost effective dose may be in the 50 unit per axilla range as it is not
clear that the 4 times dosing gives a 4 times longer response.
The method used to apply the botulinum toxin varies as well. Various
dilutions of botulinum toxin can be used as well as an iodine starch
test to identify those areas of maximally sweat output.
Treatment cost for both underarms (50 units each) or the forehead typically
costs about $1100 total. Treatment of each palm typically runs $1100 as
well. Patients preferring the higher dose botox therapy will obviously
have to pay more but may feel it is more convenient to do so.
Patients who want to learn more about hyperhidrosis surgeries can visit
many web pages. There are, however, a group of patients who are convinced
there is long term harm with these procedures. I do not do surgery myself,
I wish only that potential patients hear all sides of the story. Therefore,
patients considering surgery are encouraged to read this web
site.
Potential patients are encouraged to
email Dr. Loftus with
questions in advance of an appointment. This will allow Dr. Loftus to have botulinum toxin available
at the time of the visit. In addition, a topical anesthetic can be called in advance of the appointment.
The anesthetic has to be applied for one hour prior to the injections.
Dr. Loftus injecting the left underarm
A series of injections are made in the underarm to treat axillary hyperhidrosis.
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