Overproductive Sweat Glands (Hyperhidrosis)
Overproductive sweat glands are a relatively common problem. The symptoms are wet, clammy hands, pronounced sweating in the armpits and, more rarely, generalized sweating over the whole body. Frequently, the person affected feels very uncomfortable about it and the topic is suppressed. It is therefore not widely known that there are very effective methods of treating this problem, which can alleviate the symptoms that may be an obstacle in the patient’s private and professional life. Unfortunately, medical insurance companies do not offer coverage for the most effective treatments. Private medical insurance policies are the exception to this.
Hyperhidrosis may be treated in two ways, both effective and with minimal risks:
1. In the under-arm region through sweat gland suction. This enables the symptoms to be alleviated considerably. This treatment can be carried out as an outpatient procedure. As with liposuction (see relevant section) a tumescent solution is injected and the glands are then removed using a special cannula. It is not possible to remove all sweat glands through this method, and some residual function will remain. The result is permanent, however. Generally patients remain completely ‘dry’ for four to eight weeks following the operation. After this time, small nerves regenerate and the remaining glands start to produce some sweat, but now in quantity that is either minimal or, at the most, normal. Only in rare cases (around 5%) is it necessary to carry out a second operation, specifically when too many glands remain in one place and “sweat islands” or “sweat streets” emerge. Possible risks include complications with the wound healing process, damage to nerves, infections and others. You will be informed in full about the very slight risks associated with this operation during consultations. This method is not suitable for hands or feet.
2. Treatment with botulinum toxin (known as Botox® or Dysport®). In such cases an operation is not necessary; the sweat glands are separated from the nerve system using medications and can no longer receive the command to produce sweat. The result of this operation is near total dryness of the areas treated. This effect is not long lasting; the area must be re-treated after six to nine months. The great advantage of this technique is that it is almost entirely risk-free. Complications are extremely rare and there are no restrictions placed on the patient following treatment. As is always the case with botulinum toxin, the maximum effect occurs after around two to seven days and the effect begins to recede gradually after around three months. After around twelve to fifteen months the effect has usually completed subsided. This method is suitable for hands, feet and the under-arm region.
3. Other methods include cutting the nerves (ETS – endoscopic thoracic sympathectomy) with an increased operative risk and possible compensatory sweating at other points, the older technique of completely removing sweat glands in the under arm area (with obvious scars that heal with difficulty), and iontophoresis, (electrical treatment) which has at most only limited effectiveness. Medical insurance companies frequently insist that these latter are performed, until finally a different therapy may be carried out. Sometimes treatment is attempted by administering medications for Parkinson’s disease, anti-depressants, tranquilisers etc. These usually result in more side effects than the original desired effect, i.e. an end to the sweating. Since it has no serious side effects, the prescription of an ointment is the best of these alternatives. Unfortunately its effect is rarely to the patient’s full satisfaction. Other therapies that can be helpful may also include psychotherapies such as autogenous training or yoga, especially in cases of generalized sweating.
ALCL (Aluminium chloride) or Odaban as a 10-20% solution can also be beneficial, but are often very irritating to the skin and therefore not desirable treatments for many patients.
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