When Breaking Out In Sweat Is Not Normal

When Breaking Out In Sweat Is Not Normal

Dr Wong Su Ni. Photo by Dr Wong Su Ni

Dr Wong Su Ni. Photo by Dr Wong Su Ni

Do you sweat so much that you are afraid to hold a grabpole in the MRT during rush hour? Fret not, not only are you not alone (10 to 15 percent of the population experience excessive sweating), there are viable solutions, according to Dr Wong Su Ni from Dr SN Wong Skin,Hair,Nails And Laser Specialist Clinic at Mount Elizabeth.

(Q) What is considered excessive sweating?

(A) Sweating is a natural phenomenon. Sweating is the body’s way of maintaining a normal body temperature. However excessive sweating, also called hyperhidrosis, means that you sweat far more than your body needs you to sweat. You are likely to be suffering from hyperhidrosis if you sweat while sitting calmly at your desk or have to change clothes several times a day even when your office is air-conditioned.

In people who have hyperhidrosis, the sweat glands (eccrine glands in particular) are stuck in the “on” position so they sweat almost constantly but they also overreact to stimuli such as exercise, room temperature, anxiety and spicy food.

(Q) Do Singaporeans actively seek help when it comes to excessive sweating? Or just brush it off?

(A) It can be a very distressing and embarrassing condition but many suffer in silence after trying over-the-counter antiperspirants, as they may not be aware that effective treatments are available and are unsure whom to consult.  In the past, those who consulted dermatologists for excessive sweating were put off by the thought of surgery, and the pain and short-term nature of botulinum toxin treatments. I expect many more people will seek treatment now that there is a non-invasive and long-term solution.

Sweating excessively can get in the way of intimate relationships. Photo by miraDry

Sweating excessively can get in the way of intimate relationships. Photo by miraDry

(Q)  What are the treatments available for excessive sweating and the pros and cons of each?

(A) Injections of botulinum toxin A, the same treatment used for treating wrinkles, can treat excessive sweating. Multiple injections to the underarm are required to prevent the release of a chemical that signals the sweat glands to activate. The results last on average six to eight months but as it can cost as much as $2,000 per treatment, it is expensive as a long-term option. It is very effective but some patients find the injections painful. The main risk of botulinum toxin A injections is temporary paralysis of the underlying muscle possibly resulting in weakening of one’s hand grip.

You can also take oral medication in the form of anticholinergic agents, which block the nerve receptors of a neurotransmitter called acetylcholine. These medications may affect systems which contain other nerves that transmit this chemical. Possible effects are heart palpitations, dry mouth, blurred vision, constipation and urinary problems. If you engage in strenuous physical activity under the sun, beware of heat stroke as this medication shuts down sweating everywhere in the body.

Surgery is only recommended for people with severe hyperhidrosis that hasn’t responded to other oral medication or injections. During surgery, the doctor makes a fairly large incision and then scrapes out the sweat glands. There is a less invasive surgical option called suction curettage, which is a modified form of liposuction with a lower success rate. Although it is a permanent solution, surgery is very expensive, requires a considerable recovery time and leaves scars.

(Q) Other than high cost and the pain, what are the other possible downsides of traditional methods of surgically removing the sweat glands?

(A) Surgery always leaves a surgical scar, whether long (from open surgery) or short (from suction curettage). There are always risks involved in any surgery, such as infection, bleeding, haematoma ( solid swelling of clotted blood within the tissues), complications with the anaesthesia, etc, but there are no risks or downsides particularly associated with the surgical removal of the sweat glands.

However there is another surgical option which does have a known downside. Endoscopic thoracic sympathectomy (ETS), in which the surgeon makes very small incisions, inserts a scope into the thoracic cavity, and cuts the sympathetic nerves running near the spine that normally activate the sweat glands further downstream. This procedure is very effective, but almost everyone who gets ETS has to deal with compensatory sweating, which is when your body stops sweating in one area, but starts sweating more in another area (such as the face or chest) to compensate.

Removal of the sweat glands with miraDry or traditional surgery does not cause compensatory sweating.

(Q) How does the miraDry system work? And where and when did this technology originate from?

(A) The miraDry system was developed by Miramar Labs of Sunnyvale, California and cleared by the United States Food & Drugs Administration in January 2011 to treat auxilliary hyperhidrosis or excessive underarm sweating. The first miraDry came to Singapore in late 2014 but the devices were not widely available until late 2015.

It uses electromagnetic energy in the form of microwaves to preferentially target the dermal-fat interface region of skin where the sweat glands and scent glands are found. This leads to localised heating and destruction of the sweat glands without affecting deeper-lying sensitive structures within the skin. The special cooling system in the handset also helps to protect the epidermis and upper dermis from injury hence there is no surface scarring.

(Q) What are the contraindications for the miraDry system?

(A) MiraDry is contraindicated in the presence of a heart pacemaker or other implanted electronic devices. It would be wise to consult your doctor if you have had any previous surgery or radiation therapy in the underarm area such as axillary lymph node dissection.

(Q) What are the precautions a patient must take after the miraDry treatment? Is there any downtime?

(A) The miraDry procedure is performed in the doctor’s clinic and typically takes about an hour. Local anaesthesia (usually lidocaine injections) will be administered before starting the treatment. Patients usually experience little to no discomfort during the procedure and there is minimal to no downtime afterwards. A mild over-the-counter pain medication and ice packs are generally recommended for a few days. Most patients are able to return to normal activities or work right after the procedure, and can typically resume exercise within a few days.

Common and minor side effects of miraDry include underarm swelling, redness, and tenderness lasting for several days. Occasionally numbness and tingling can occur in the upper arm or armpit and may last for several weeks to a few months.

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