National Center of Excellence for Hyperhidrosis Treatment
How is Hyperhidrosis Treated?
What Can be Done to Eliminate Excessive Sweating?
The important thing to distinguish before treatment is whether hyperhidrosis is primary or secondary.
Secondary hyperhidrosis requires a comprehensive medical investigation to rule out diabetes, hyperthyroidism or other disorders causing the excessive sweating. Dr. Karamanoukian will get a complete medical history from you at the time of initial evaluation and perform an examination to delineate whether or not there is an underlying medical, metabolic, infectious, immune, rheumatologic, inflammatory or neoplastic disease causing secondary hyperhidrosis. Secondary hyperhidrosis is generalized hyperhidrosis which involves a large part of the body. Once the underlying cause is determined, secondary hyperhidrosis can be eliminated or markedly reduced without surgical intervention.
Primary hyperhidrosis can be treated with medical therapy, alternative therapy, as well as surgical intervention such as Micro ETS (the STITCH procedure) or the retrodermal suction curettage (RSC Procedure).
In general, surgery is contemplated only when the less invasive medical treatments have failed to provide adequate treatment.
It is best to get treated by a physician who provides A to Z treatment for hyperhidrosis and not just one type of treatment and not the other. Dr. Karamanoukian will give you a treament algorhythm when he is done with the consultation so that you are aware of what lies ahead and treatments are recommended. This will allow you to fulfill insurance protocols to get treatments such as Botox or micro ETS.
These agents are applied directly to the skin in the affected areas of the body and can cause skin irritation. They are quite messy on clothing and unfortunately, have short periods of efficacy, requiring frequent reapplications. They include Drysol, Certain Dry and Hypercare among others. Lower strength aluminum chloride containing compounds should be tried before prescription strength antiperspirants are used as they can cause significant skin irritation and burning in some patients.
Anticholinergic medications aim to suppress the cholinergic stimulation of the eccrine sweat glands by the sympathetic nerve trunks to eliminate or reduce excessive sweating. Anticholinergic agents such as such as propantheline bromide, glycopyrrolate, oxybutynin and benztropine may be effective in treating hyperhidrosis. However, they can cause significant adverse effects, which include blurry vision, dry mouth and dry eyes, abdominal cramps, sexual dysfunction in men (rare), palpitations of the heart, among others, thus limiting their usefulness.
Iontopheresis is an alternative treatment which utilizes an electrical stimulation to the hands. Patients are instructed to bathe thier hands in an electrolyte or tap water solution through which an electrical current is passed. This "stuns" the eccrine sweat glands of the hand, in effect decreasing the "sweat reflex" for periods of hours to weeks. Most patients find this mode of treatment as ineffective and not of durable benefit. Iontophoresis is contraindicated for craniofacial hyperhidrosis (scalp, head) and is very impractical for hyperhidrosis of the underarms and rarely effective for hyperhidrosis of the underarms.
Is Botox only for the rich and famous? Injection of botulinum toxin (Botox) into the area of excessive sweating has been shown to cause temporary benefit in hyperhidrosis. Botox affects nerve endings and decreases the transmission of nerve impulses to sweat glands, effectively reducing the production of sweat.
Multiple injections in the palms of the hand or armpit have been described as uncomfortable but tolerable by most patients. Botox for hyperhidrosis is best for underarm hyperhidrosis, followed by injections in the scalp, palms and feet, in that order of application. This study was done at the Center for Excessive Sweating following Botox injection in over 900 patients over a course of 2 years by Dr. Karamanoukian. These injections can be costly but we obtain authorization from insurance companies, whenever such policies allow for Botox injections in their protocols for hyperhidrosis. Repeated injections are nearly always required to maintain an adequate level of dryness. I recommend that patients have Botox injections at least once in their treatment plan so that they are convinced that surgical therapy is the only options that is viable for them.
What About Retrodermal Suction Curettage (RSC) Procedure?
- The retrodermal suction curettage (RSC) procedure is ideal for individuals that have hyperhidrosis of the underarms. This procedure is done using specialized instruments and probes under local and tescent anesthesia. Patients are driven in and driven home and are awake for this procedure which is done in the comfort of our surgical suites in the office. It is a very successful procedure and most patients are able to return to work the following morning and are limited from participating in sports for a week. They can drive and do almost all other activities during that time period.
When the less invasive medical treatments have failed to provide adequate treatment, hyperhidrosis can be effectively treated through surgical intervention. This is an important point, as most insurers want documented failure of conservative therapy before endoscopic thoracic sympathectomy is approved.
Hyperhidrosis surgery has come a long way in the last decade. Traditionally, large incisions were made in the chest to surgically interrupt the sympathetic trunk.
With the advent of minimally invasive techniques to work in the chest via endoscopes and surgical instruments, Dr. Karmanoukian and other leading cardiothoracic surgeons have evolved a procedure called Micro ETS which is very effective in treating patients with sweating of the hands, underarms, face, scalp as well as patients that have facial blushing.
Dr. Karamanoukian, Director of The Center for Excessive Sweating has pioneered a variant of Micro ETS (Endoscopic Thoracic Sympathectomy) coined STITCH, Sympathetic Trunk Interruption with Titanium Clips for Hyperhidrosis.
The STITCH procedure is a revolution in Micro ETS for excessive sweating. With the STITCH technique, the incision is smaller and less invasive than traditional Micro ETS procedures.
This is the most durable treatment for hyperhidrosis when performed by experienced hands. Clipping the thoracic sympathetic trunk at the appropriate levels will immediately eliminate hyperhidrosis.
It is not uncommon for patients to wake up from anesthesia and almost immediately take note of a dry hand or underarm. With modification of the level of sympathectomy, compensatory hyperhidrosis is also minimized or eliminated.
Micro ETS or Sympathetic Trunk Interruption with Titanium Clips for Hyperhidrosis (STITCH) can be performed with minimal side effects and excellent outcomes. The procedure is performed in an outpatient setting and takes less than 45 minutes to complete, including anesthesia time. In most cases this procedure is covered by medical insurance.
What's Best for Me?
Talking to your physician should help point you in the right direction. After a thorough discussion, surgery may be the definitive solution.
If you are ready to eliminate hyperhidrosis from your life, contact Dr. Karamanoukian at The Center for Excessive Sweating, a National Center of Excellence for Hyperhidrosis Treatment by email or by phone at (716) 839-3638.