For many people, sweating is a source of secret insecurity and embarrassment. I remember walking in to an exam room to see a young male landscape architect. As I typically do, I stuck out my hand and with a big smile introduced myself as Rebecca Reinke, PA-C. “How can I help you?” Before returning the gesture, he sheepishly wiped his right hand along his jeans and uttered an apology as he engulfed my hand in a moist grip. During our 15 minute conversation, this gentleman relayed a history of tools slipping from his hands, embarrassing encounters during dates, and now complete frustration with trying to hide this condition from clients. All the while, sweat dripped from his hands into a small pool on the exam room floor. Hyperhidrosis of the hands had infiltrated every aspect of his life.
Occurring exclusively during and after puberty, hyperhidrosis is a condition of excessive activity of the sweat glands affecting mainly the armpits, hands, feet, or all three. First line of treatment usually involves the use of Aluminum Chloride, a potent antiperspirant. The idea behind an antiperspirant is to decrease perspiration. This indirectly affects overgrowth of odiferous bacteria in sweat-prone areas. Second line of treatment may involve oral anticholinergics, such as Robinul Forte, or solutions with positively charged ions called iontophoresis.
What works better than anything else may come as a surprise. BOTOX® injections in the proximity of the sweat glands, dramatically stunt its activity by stopping the transmission of acetylcholine, a neurotransmitter that acts as sweat gland fuel. Patients typically notice therapeutic benefit within two weeks of injections with continued results for 6 months or longer. Personally, there aren’t many procedures I find more rewarding. On the second visit, usually 6 months later, fear of needles is replaced with a “bring on the BOTOX” attitude. Amazingly, our patients almost always smile intermittently during the procedure and thank us repeatedly afterwards.
Thanks to the incidental finding that reducing forehead wrinkles with BOTOX® also reduces forehead perspiration, no one needs to suffer in silence anymore. Hyperhidrosis has found its voice.
– Rebecca Reinke, PA-C
