Nothing but the truth! Palmar and plantar HH By Dr Davin Lim...
Everyone sweats, however some people may sweat more than normal.
Abnormal sweating is when sweating has an impact on your lifestyle. Questions to ask include the following:
Do you have foot problems including odour from sweating?
Do you leave damp footprints on a floor?
Does your sweating limit what your wear on your feet?
Hyperhidrosis or excessive sweating is a medical condition that affects 2-3% of the population. Excess sweat can occur in all places including the armpit, hands, feet, and face areas. In fact, some people have excessive sweating in more than one area.
Most cases of excessive sweating are idiopathic and primary- the cause is unknown, but maybe genetically linked. Excessive feet sweating is seen in 2% of the population, and can be related to skin problems (see below).
Sweaty feet can be significant for patients, both at work and socially. Excess sweat on the feet can also result in skin disorders.
Smelly feet, or malodour is secondary to bacteria. This condition is due to a species of bacteria called Corynebacterium and may cause a condition known as pitted keratolysis. The bacteria is part of your normal skin population, but excess sweat provides a haven for growth. This in turn creates the smell of sweaty feet. Treating the infection is simple, but treating the underlying cause of excess sweat can be challenging.
Excess sweating can also be associated with fungal infections, including tinea.
Other conditions associated with abnormal sweating of the feet include a condition called pomphylox eczema. This condition can present as tiny itchy bubbles which can form blisters on the feet and on the hands. This is thought to be related to dysfunction in the sweat glands.
Friction blister can also occur due to excessive sweating, and this is common in runners.
Simple basics form the foundation of plantar hyperhidrosis (sweaty feet). This includes wearing cotton socks, using an absorbable insert to mop up excess sweat, and treating any secondary skin condition associated with hyperhidrosis.
The next step is a trial of an antiperspirant such as Driclor. 20% of patients may respond to this simple treatment, but it is worth a try!
Iontophoresis involves using a current to carry ions , minerals and drugs into the sweat channels. This procedure can be successful in 50-60% of cases of plantar sweating. Our specialists can either use tap water (given the high mineral content and hardness of Brisbane water), mineralised water, or compounded solutions of Glycopyrrolate.
Tablets such as anticholinergics can help many cases of sweaty feet. The limiting factor of tablets are side effects such as drowsiness.
Sweat stopping treatments injections are great for axillary (armpit) sweating, as well as facial and scalp hyperhidrosis. These injections can also be used on areas such as the hands and feet. Our specialist however recommend sweat stopping treatments as last line treatment of sweating of the feet. The costs, coupled with the shorter duration of remission, limits it’s use in this setting.The exact cause of rebound sweating is poorly understood, however a theory is that the perception of a part of your brain called the hypothalamus, senses that your body temperature is too high. This stimulates nerves which in turn activates sweat glands in certain areas to sweat, which in turn reduces body heat.
This specialist procedure delivers an anti-sweating drug known as Glycopyrrolate directly into the sweat glands. This inturn reduces the input for sweat production. Iontophoresis uses a very low electric current to draw ions and drugs directly into the eccrine or sweat units and concentrates the treatment where it is needed most.
This treatment has a success rate of over 80% for sweaty feet.
Yes and no. sweat stopping treatments is best used for excessive sweating of the axillary or armpit area. It can also be an excellent treatment for facial sweating and an option for sweating of the hands.
It can work for sweaty feet, but it is a last line treatment. Why? It is because the treatment tends to wear off by the third to fourth month, unlike sweat stopping treatments of the armpits, where it tends to last a lot longer. Secondly, more sweat stopping treatments is needed in the palms and soles, which adds cost to this procedure. Thirdly sweat stopping treatments to the hands and feet is NOT subsidised under the PBS, this compounds the cost for patients.
The sweat stopping treatments procedure on hands and feet can be painful, however that is a minor issue because our Specialists have special anaesthetic creams and Nitrous to alleviate the discomfort of sweat stopping treatments injections. In summary, we do perform sweat stopping treatments for sweaty feet, but we advise patients to try all other treatments first!
Surgery such as ETS can be successful for sweaty armpits and sweaty hands, however this procedure is not available for sweaty feet. Localised surgery can be used for sweaty armpits, but removing sweat glands from the feet is not possible.
In summary surgery is NOT and option for sweaty feet.
Basic foot care can not be over emphasised. Wearing cotton socks is both cool and can reduce irritation. Avoid nylon! Change your sock frequently – possibly 2-3 times a day. If you soak thru one pair, wear two pairs, then change thru out the day.
If your feet has evidence of fungal infection, visit your GP for a skin scraping or treat with Lamasil.
If your feet smell, consider secondary infection as a cause. Treat pitted keratolysis secondary to bacterial infection. We advise either-
Erythomycin 400mg 2 tabs twice a day, for 14 days
Clindatech solution or Ery 2% gel: dab on twice a day
Condy’s crystals: Pale pink solution, soak for 15 minutes twice a day
Miconazole cream: Over the counter medication, twice a day
We advice all patient to try Driclor antiperspirants before visiting us! This can be effective in up to 20% of patients with excessive feet sweating.
A good tip to help absorb excess sweat is to buy an insert to place in your shoes. This helps mop up sweat, and makes life a little more comfortable. Remember to also wear cotton socks, and if needed change your socks thorough out the day.
For more on shoe inserts go to www.summersoles.com
Excessively sweaty feet is a difficult condition to treat, however effective treatments are available. Prior to seeing us, you should have some basic understand about the available treatments.
Our specialist at Sweat Free will take a detailed history and examination during the initial consultation. In some cases we may investigate by performing a swab to make sure you do not have any secondary infection.
Our first line treatment is with Iontophoresis. This involves several visits to the Sweat Free Clinic.
Failing Iontophoresis, treatments such as sweat stopping treatments maybe indicated however this is last line therapy.
Dr Davin S. Lim
Director Sweat Free Clinics
Plantar hyperhidrosis or excessive sweating of the feet is one of the harder areas to treat. Compared to axillary or armpit sweating, sweat stopping treatments is not subsided under Medicare, more units are needed, and costing is a significant issue. Surgery such as ETS is not an option for plantar sweating but maybe useful for sweaty hands. Patients are left with antiperspirants, tablets, creams or iontophoresis.
Basic foot care forms the absolute most important cornerstone of excessive foot sweating, this can not be over emphasised. DRICLOR is worth a try, however the success rate is less than 20%. Treating any secondary infection such as bacteria or fungus is very important. Using a very simple technique of Condy’s soaks can help!
Iontophoresis is the next step. In our experience up to 80% of patients respond to this treatment. I usually start with tap water, move up to baking soda (given the high mineral content of Brisbane water), then up to Glycopyrrolate solution. Tablets such as Propantheline Bromide can be helpful, but side effects are seen in the majority of patients. I sometime use old fashioned Formaldehyde soaks, or compound Glycopyrrolate. sweat stopping treatments can be useful, but it is not subsided under Medicare, unlike armpit sweating, and can be very expensive. This is last line treatment. Unfortunately surgery is NOT an option.