Nothing but the truth! Palmar and plantar HH By Dr Davin Lim...
Underarm sweating is a common condition, however the severity will be different for each person. When underarm sweating gets in the way of your personal and work life, the condition does have a significant impact for you!
Ask your self the following questions to gauge the impact of underarm sweating:
Are you worried that people notice your sweat stains and patches?
Are you worried to raise your arms because of sweat patches and stains?
Does underarm sweating limit your choice of clothes?
Do you usually wear only black or white colours?
If you answer ‘yes’ to any of these questions, underarm sweating does have an impact on your life, and yes, we can help!
Excessive sweating is a common condition that is not well managed in our community. Hyperhidrosis can affect many areas of the body including the hands, feet, face – scalp and commonly the underarms. Most cases of underarm sweating is primary and idiopathic. That is to say the cause is unknown, but in many cases patients who suffer from sweaty armpits will have a family member with a sweat disorder. The underarm area or axillary vault, like your hands, feet and face, contain a large number of sweat glands (eccrine units), these areas are primarily involved in hyperhidrosis.
Severe axillary or armpit sweating is a medical condition that involves over active eccrine or sweat glands. A simple set of questions can gauge the impact of this condition on your life.
Examination of the underarms can provide the most useful clue to the severity of your sweating. Most patients we see at Sweat Free will have beads of sweat on the underarm skin. In severe cases, sweat flows freely.
An accurate way to measure the area of maximal sweating is called the starch iodine test. This test is not routinely performed, however it is a simple and accurate method of ‘mapping out’ your s maximal sweat areas.
Now, more than ever, there are a number of treatment options for patients who suffer from underarm sweating. The Sweat Free clinic always encourages simple over the counter treatments as first line treatment.
Driclor antiperspirants and deodorants
Antiperspirants such as Driclor are available without prescription from your pharmacy. If applied correctly, they can help reduce underarm sweating by blocking sweat ducts, thereby reducing the amount of sweat that reaches the skin’s surface.
Prescription tablets for sweating
There are a number of tablets that can be useful for underarm sweating. These group of tablets are called anti-cholinergic medications, and can be obtained via a prescription. The most commonly used tablet is called Propantheline Bromide. This tablet can reduce underarm sweating by 20-50% however side effects such as sedation, dry mouth and blurred vision may occur.
Sweat stopping treatments injections
Sweat stopping treatments injections has revolutionised the treatment of axillary or underarm treatment. This treatment has been listed on the PBS under Specialist Use for the treatment of severe underarm sweating when other skin directed treatments (Driclor antiperspirants) do not work. This treatment blocks the chemical stimulation of nerves that activate the sweat glands. The treatment is effective in over 90% of cases and lasts between 6-8 months.
Alternative therapies and lifestyle changes
A number of herbal remedies such as St John’s Wort, Nat Mur, Sage, Chamomile and Argentum have been reported to reduce underarm sweating.
Biofeedback and meditation can be very useful if stress plays a part in excessive armpit sweating.
This treatment involves treating your sweat glands with an electrical current. It works better for palmar (sweaty hands) as well as plantar (sweat feet) hyperhidrosis. Iontophoresis of the armpits can be achieved with a pad, and can be effective in 20% of patients.
There are several surgical techniques for underarm or axillary sweating. The most promising surgical procedure is known as ETS or endoscopic thoracic sympathectomy. This procedure can be used for underarm sweating, facial sweating, and palmar (sweaty hands) hyperhidrosis.
Keep in mind that sweat stopping treatments management is not the treatment of choice for all people with underarm sweating. Our Specialist will guide you as to the correct method to treat your excessive sweating. Sweat stopping treatments is only indicated if you have failed antiperspirants such as DRICLOR or if you have skin irritation secondary to antiperspirants.
If you are a candidate for sweat stopping treatments, under the PBS rules, you maybe entitled to up to 3 injections per year, subsidised under Medicare. The sweat stopping treatments procedure takes only 5 minutes to perform and each armpit will receive 10-12 injections. You will start to notice a reduction in sweating within a week or two, and this sweat reduction will last up to 6-7 months.
If you are after a permanent method to stop excessive underarm sweating, miraDry is the answer. Patients will require 2 treatments spaced 3 months apart.
miraDry is the absolute permanent answer for excessive underarm sweating. It works by electromagnetic energy that is precisely delivered to the eccrine or sweat glands in your armpit. Each treatment takes one hour to perform and is painless (anaesthetic is used). After miraDry treatment, your armpit will be red, and slightly inflamed for a few hours, but you can continue your normal activities. There will be an immediate and noticeable sweat reduction after just one treatment. This procedure is repeated again in 12 weeks.
Yes! Excessive underarm sweating, or axillary hyperhidrosis is now covered under Medicare! There are however guidelines that need to be followed, including-
You must try an antiperspirant such as Driclor before sweat stopping treatments. In some cases this is a simple solution to reduce sweating in mild cases of underarm hyperhidrosis. For patients with moderate to severe sweating this treatment will not work, or skin irritation will occur. DRICLOR can be bought through any pharmacy.
Failing DRICLOR, or if skin irritation occurs you will qualify for sweat stopping treatments providing the procedure is conducted by a qualified Specialist.
Medicare provides a PBS subsidy for up to 3 sweat stopping treatments injections per year.
NOTE: under PBS ruling, this treatment is only applicable to severe underarm sweating, failing Driclor (or if skin irritation occurs), AND if only if the procedure is conducted by a Medicare approved Specialist.
Treating excessive underarm sweating, also known as axillary hyperhidrosis is cheaper than you may think!
Your first consultation at Sweat Free is claimable via Medicare and an out of pocket consultation fee of $25 applies. During this consultation we will provide you a guide in regards to treating underarm sweating, including assessing your sweat severity, treatment options and cost of treatments. Our aim is to find the most cost effective solution to your sweat problems.
Initial Assessment: $80 (Specialist Hyperhidrosis nurse practitioner)
Testing including pathology: Bulk billed
Specialist Dermatologist Review: Call for more details
Specialist Vascular surgeon consult: Call for more details
sweat stopping treatments for underarm sweating: Call for more details
Sweat Free Clinics are a National Association of Hyperhidrosis Specialists comprising of Dermatologists, Vascular surgeons, Specialist Nurse Educators and Dieticians. As per Medicare rules, a referral is need to access Medicare rebates for the consultation as well as treatments such as sweat stopping treatments injections for sweaty underarms.
We suggest printing this Hyperhidrosis referral form and asking your GP to fill it out. This also provides an avenue to communicate with your GP and reinforces that medical treatments can be highly successful for most cases of hyperhidrosis.
Sweat Free Brisbane is unique as we have a full time Hyperhidrosis Nurse Practitioner. You can visit this clinic without a referral if you like, as our nurse can generate a referral to see our Specialists. With your permission Specialist at Sweat Free Brisbane will also correspond back to your usual GP to inform them of your treatment.
Dr Davin S. Lim
Consultant Laser Dermatologist
Sweat Free Clinics
Axillary hyperhidrosis is a very common condition, affecting over 2% of the population. Like most cases of excessive sweating, it ranges from mild to very severe. The impact of underarm sweating can be assessed by asking only a few very basic questions- does sweating limit what you wear? Are you apprehensive to raise your hands due to sweat patches? Are you embarrassed if people notice your sweat patches? If the answer is yes, then you should treat your condition.
In reality only 3 things work, for patients who have mild sweating, DRICLOR is the first step. For patients who suffer from moderate to severe underarm sweating, DRICLOR will create skin irritation in the majority of patients. The next step is sweat stopping treatments. This is now covered under the PBS for cases of severe underarm sweating if Driclor does not work. The procedure is successful in up to 95% of cases, and lasts 6-7 months.
ETS surgery or endoscopic thoracic sympathectomy is reserved for patients who do not respond to sweat stopping treatments injections, or if sweating of the underarms is associated with palmar (hand) hyperhidrosis. ETS has an extremely high success rate, however patients will have to be mindful of compensatory sweating elsewhere.