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Excessive Sweating: A Sticky Subject

WebMD goes to the experts to find out what may cause this embarrassing yet common condition and what can be done to treat it.

Botox: A 'Revolutionary' Treatment for Excessive Sweating? continued...

Commonly thought of as a wrinkle treatment, Botox has "revolutionized" sweating treatment because it is so effective and can treat almost any area of the body, Glaser says. More people who do not suffer from hyperhidrosis are starting to use Botox cosmetically. Glaser has used it on brides-to-be who don't want to stain their wedding dresses on their big day.

Botox is only a temporary solution, however, and injections must be repeated about once every six months. And even though the FDA has approved Botox for use under the arms, some insurance companies do not cover it. Barry says Botox helped her "dramatically" when she took it as part of a study. But when the study ended, her insurance wouldn't cover the injections, which can cost as much as $1,000 per session. 

Other available treatments for excessive sweating include:

  • Special Deodorants. This is the typical first-line treatment. Over-the-counter antiperspirants that offer "clinical strength" usually have aluminum zirconium as an active ingredient and are often applied at night. These are "a little stronger" than typical antiperspirants, and many find them effective, Glaser says. Prescription-strength Drysol (containing aluminum chloride) is also effective in some people, but it can irritate the skin.
  • Iontophoresis. This painless procedure uses water to conduct an electrical current through the skin. Some iontophoresis machines can be used at home; others must be used at a doctor's office. Iontophoresis can be effective, but only on the hands or feet, and the procedure typically must be repeated two or three times a week.
  • Oral Medications. Drugs known as anticholinergics stop sweating as a side effect. Glaser will sometimes prescribe anticholinergic medications such as Robinul. But the pills can stop all sweating, making them inappropriate for athletes or people who work outside. Barry controls her sweating with Robinul, but she suffers from dry mouth, a common side effect.
  • Surgical Tumescent Liposuction. This is a cosmetic procedure in which surgeons use tiny instruments to remove the sweat glands. It is performed as an outpatient procedure under local anesthetic, and its effects are generally permanent. It is only used to treat sweating under the arms.

Surgery: Best Solution or Last Resort for Excessive Sweating?

In a controversial procedure known as a sympathectomy, a surgeon cuts a portion of a nerve inside the chest, permanently interrupting the nerve signal that causes the body to sweat excessively. Joseph Coselli, MD, a surgeon at Baylor College of Medicine in Texas, says his patients are amazed to wake up from surgery with their hands completely dry for the first time in years. Unlike other treatments, a sympathectomy is designed to be a one-time, permanent procedure.

In the past, a sympathectomy was a major surgery because it required opening up the chest or back. Today, it is performed with tiny instruments and a camera that are inserted into the body through a small incision, a method known as endoscopy. This has turned it into an outpatient procedure. But the surgery remains controversial because of a phenomenon called compensatory hyperhidrosis. While sweating may have disappeared from the hands and armpits, sweating may increase elsewhere in the body, such as chest, back or legs. In people with hyperhidrosis, says Coselli, "the sympathetic nervous system is hyperactive. When you knock out part of it, other parts rev up and take over."

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