Excessive Sweating Can Be Treated By An Experienced Orthopedist
Sweating is a normal bodily function that helps one maintain a normal temperature. The nerves that control our sweat glands’ activities respond to temperature, stress, exercise and other factors that increase one’s internal temperature. However, excessive sweating is unnecessary, and can interfere with normal life. This problem can be treated by an orthopedist.
People with hyperhidrosis may sweat up to five times as much as a normal person. There are about 1.3 million people in the U.S. that have this condition. Unfortunately, only about two-thirds of them have ever discussed this with a doctor. Hyperhidrosis typically affects those in their working-years (18-54 years old).
Excessive sweating can be treated by an orthopedist – a doctor who specializes in the diagnosis and treatment of the musculoskeletal system (including bones, joints, ligaments, muscles, tendons and nerves). Excessive sweating and in the feet and armpits is especially problematic.
It is important that your orthopedic doctor make sure that the excessive sweating is not from another condition. However, once diagnosed with primary hyperhidrosis, you should be made aware of your treatment options. Treatment depends upon the severity of the disease. If there is focal (on a particular area) and visible sweating for at least 6 months, without a cause, then there is hyperhidrosis. The disease severity ranges from 1 to 4.
Hyperhidrosis Disease Severity Scale
(Lowe, et al. J Am Acad Dermatol. 2007)
- Never noticeable and never interferes with my daily activities
- Tolerable but sometimes interferes with my daily activities
- Barely tolerable and frequently interferes with my daily activities
- Intolerable and always interferes with my daily activities
If you score a 3 or a 4, you have severe hyperhidrosis. Research done in this field has shown what treatments should be used at each stage of this condition.
Treatment Options for Excessive Sweating
Initially and with lower severity of the disease, topical OTC (over-the-counter) antiperspirants may be used. These may then graduate to aluminum chloride 10-35% topical antiperspirants. If the topical treatments fail, then intradermal injections of Botulinum Toxin Type A (Botox) are recommended. Finally, an orthopedic surgeon can make recommendations for the most recalcitrant of cases: either the sweat glands or the nerves that make the sweat glands overwork are removed.
There are no oral FDA-approved medications to treat this condition. However, there is some history of doctors prescribing medications known as anticholinergics for hyperhidrosis, including: glycopyrrolate, oxybutynin, benztropine and propantheline. No approved studies have been completed on these medications for this use, and therefore they are not FDA-approved. Many insurance companies will not pay for any treatment that is not FDA-approved.
If you have primary hyperhidrosis and have tried strong antiperspirants without success, you may be a candidate for Botox injections. Botox works by blocking the signal from the nerves that tell the sweat glands to work. Botox is injected into the areas that have the hyperhidrosis, effectively preventing the sweat glands from working for up to six months. Botox has been safely used since it was isolated in the 1920s. It is approved for use in 83 countries and is FDA-approved for hyperhidrosis treatment. There has been research accomplished that demonstrates Botox to be both safe and effective for this condition. (Lowe and Naumann et al. Br Med J. 2001).
Orthopedist Dr. Warner Advises:
Botox Injections for the Treatment of Hyperhidrosis of the Feet and Armpits
Dr. Warner will meet with you and determine if you have primary hyperhidrosis of the feet/armpits or if there is a more easily treatable reason for the excessive sweating. Once the diagnosis is established, she will analyze your condition and categorize the disease.
If you have severe primary hyperhidrosis, then treatment will begin. Dr. Warner will want to make sure you have tried topical antiperspirants, including stronger ones with aluminum chloride. If it is established that you have tried these, activity modifications, different clothing, stress-reduction techniques and finally treatment with Botox will be considered.
Dr. Warner and her staff will determine if your particular insurance plan will allow her to treat you with this proven technique. Often, this determination takes a week or more. Many insurance companies will deny this request initially and Dr. Warner will need to schedule a conference with the insurance company’s medical director on your behalf. If treatment is approved, her office staff will call you to schedule your treatment session.
How to Prepare for Botox Treatment for Hyperhidrosis
Prior to the treatment you should shave the armpits (one day before treatment)
Do not use deodorants or antiperspirants for 24-hours prior to treatment. Ensure that you relax and rest for about 30 minutes prior to the treatment session.
What to Expect During the Treatment
Dr. Warner will place iodine liquid on your feet, hands or armpits. Once the iodine dries, starch will be applied in the same areas. The iodine will react and turn the starch purple wherever there is excessive sweating present. These areas will be targeted for injection therapy. A very small needle is used so that the procedure is relatively painless. In addition, a cold spray may be used to reduce the sensation from the needle. Anesthesia may be used as well.
Dr. Warner and her orthopedics team value your comfort during this procedure and will do everything necessary to ensure there is minimal pain during the injections. If necessary, Dr. Warner may even apply an anesthetic cream to the area prior to injecting the Botox.
Dr. Warner only uses Botox that is made by Allergan; this is the safest and most effective formulation in her opinion.
Possible Side Effects of Botox
There are some side effects to Botox injection therapy treatment. These effects are described in detail on the medication guide available on the Botox website. However, some of the possible side effects include: dry mouth, headache, double vision, blurred vision, rash, itching, asthma symptoms and/or feeling faint.
More information about the orthopedic ailment hyperhidrosis is available at www.dontsweat-it.com.
Image courtesy of Ambro / FreeDigitalPhotos.net
Dr. Meredith Warner is a board certified, Fellowship Trained Foot and Ankle, Orthopedic surgeon practicing in Baton Rouge, Louisiana. Dr. Warner is committed to offering her patients an accurate diagnosis along with a comprehensive treatment plan in order to get them back to a pain free life. Dr. Meredith Warner specializes in the treatment of orthopedic issues, providing operative and non-operative treatment plans of orthopedic problems, including musculoskeletal pain such as chronic back, neck and foot pain, reconstructive surgery of the foot and ankle, arthritis, diabetic, hammer toe, bunion, wound care, work injuries, fitness and nutrition and osteoporosis issues.