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Excessive Sweating of the Hands

Author: Dr Naomi / 28 Oct 2015

TREATING EXCESSIVE SWEATING IN UNDERARMS WITH INJECTIONS
Excessive sweating of the underams also called axillary hyperhidrosis, is a common problem, which is quite disturbing to the sufferer. They complain that they can only wear white or black clothes, that it is really embarassing.
Sometimes excessive sweating is genetic, and will run in a family.
Small injections with a very fine needle in the underarm are used to resolve the excessive sweating problem
The consultation for excessive sweating assessment
History-taking  is very important in the treatment of excessive sweating. The following should be explored:
Is there a genetic component? ie are there others in the family who have excessive sweating?
Has the patient had treatment before?
Were they happy with treatment every time?
Did the effect of toxin injections last well?
Which area came back first?
How is the patient’s metabolism? Do they exercise? Are they very muscular? Do they have trouble putting on or losing weight?
Are there any other areas of excessive sweating, including back, hands or feet.
Have they every had any complications with injections for excessive sweating before, including arm weakness, perceived increase in sweating elsewhere.
The examination
The doctor may decide to do an iodine starch test, where she will first  wipe the patient’s underarms with betadine wipes and then pour some cornstarch powder in the area. This will show exactly where the sweating problem exists.
Choosing the dose for excessive sweating
The doctor will assess the sweating and decide on the best dose after taking a history and examining the patient. In particular discussing with the patient re their budget.
There are a couple of options for dosage for excessive sweating. A larger dose may be used, which costs about $990 or a smaller dose may be used (cost approx $680) the difference will be the longevity that is obtained.
If the patient has a history of poor longevity, or needing high doses or wanting maximal effect, then a higher dose may be suggested
If a patient has a history of complications with muscle relaxing injections, or if their budget is small or if they want a more subtle result, then a smaller dose might be chosen.
Pain relief during treatment
A numbing cream (eg EMLA or LMX ) may be applied to the area prior to the treatment (45 minutes prior is ideal) Glad wrap may be used over the numbing cream to increase its effect.
Most patients do not bother with numbing cream because it takes so long to work and because the treatment isn’t very painful anyway.
Ice is always used to decrease pain and to reduce the risk of bruising.
Very rarely  patients will use Penthrox for excessive sweating treatments
Nitrous oxide (Happy Gas) is available for use for injections for excessive sweating under the arms
What happens during the excessive underam sweating treatment itself?
EMLA can be applied to the underarm and covered with gladwrap for 45 mins prior to the procedure

The underarm will be cleaned with alcohol.
Ice will be applied to the area briefly before treatment
The doctor will inject at least 15 sites on each underarm. Then pressure with gauze will be applied.
The procedure itself takes less than 10 minutes.
How do I look afterwards?
Sometimes there is nothing to see. Sometimes there can be redness, small lumps, which can look like mild acne and usually resolve quite quickly.
Typical problems which can occur:
In general, treatment of  excessive underarm sweating is very low risk.
Headache happens in around 10% of new users.
Bruising occurs in a significant number of cases.
Asymmetry: One side may be better treated than the other, this is usually because the patient has asymmetrical sweating to start with..
Infection is a very rare complication, but always a possibility when the needle goes into the skin.
There is a low risk of arm strength being affected.

There is a possibility of a perceived increase in sweating in other areas of the body eg face, back, palms, feet.
Who is unsuitable for treatment of excessive sweating?
Most people with a excessive sweating are suitable for this treatment.

Pregnant and breastfeeding women can’t have the treatment
Instructions for care afterward
No deodorant for 4 hours
No massage that day
No heavy exercise that day
What to expect after excessive sweating of underarms treatment?
The effect of the injections may start to occur within 2-8 days.
The maximal effect of the drug will be at 3-4 weeks, so a review should be booked if required  for 4 weeks. If at that time, further treatment is necessary, it should be performed. The starch iodine test may be necessary
What if I get asymmetry of sweating or I am still sweating at some time before the 4 week point? Do I call the doctor?
No. No need to call the doctor. Sometimes asymmetry will occur because one side just comes on quicker than the other. Usually it will right itself by the time of the review appointment. If it doesn’t, then it can be treated at the review appointment. There is no point in coming in early for treatment of asymmetry.
What do I do if at 4 weeks post treatment one side is better treated than the other?
This is not uncommon, at your 3 week review appointment, further treatment may be administered.
How long will the treatment last?
The answer to this is very individual and depends on the patient’s metabolism, the dose, the placement etc.
At a higher dose, about 30% of patients will get 1 year out of the treatment.
The rest will probably require retreatment at 8 months.
At a smaller dose, retreatment may be required several months earlier than above
When should I have my next treatment for excessive sweating of the underarms
When the sweating recurs or at 1 year, whichever occurs first
How much does it cost for excessive sweating of underarm treatments?
$680-$1020

TREATING EXCESSIVE HAND SWEATING WITH INJECTIONS
Excessive sweating of the hands, also called palmar hyperhidrosis, is a common problem, which is quite disturbing to the sufferer. Those affected complain that their jobs are affected, they hate shaking hands, and that it is really embarrassing.
Sometimes excessive sweating is genetic, and will run in a family.
Small injections with a very fine needle are used to resolve the excessive sweating problem

The consultation for excessive sweating assessment
History-taking  is very important in the treatment of excessive sweating. The following should be explored:
Is there a genetic component? ie are there others in the family who have excessive sweating?
Has the patient had treatment before?
Were they happy with treatment every time?
Did the effect of toxin injections last well?
Which area came back first?

Which areas of the body are affected by excessive sweating?
How is the patient’s metabolism? Do they exercise? Are they very muscular? Do they have trouble putting on or losing weight?
Are there any other areas of excessive sweating, including back, underarms or feet.
Have they every had any complications with injections for excessive sweating before eg muscle weakness or perceived increase in sweating elsewhere.

What is the patient’s occupation and hobbies, the potential complication of muscle weakness in the hands needs to be discussed
The examination
The doctor may decide to do an iodine starch test, where she will first  wipe the affected area with betadine wipes and then pour some cornstarch powder in the area. This will show exactly where the sweating problem exists.
Choosing the dose for excessive sweating
The doctor will assess the sweating and decide on the best dose after taking a history and examining the patient. In particular discussing with the patient re their budget.
There are a couple of options for dosage for excessive sweating of the hands. A larger or smaller dose may be chosen, the difference will be the longevity that is obtained.
If the patient has a history of poor longevity, or needing high doses or wanting maximal effect, then a higher dose may be suggested
If a patient has a history of complications with muscle relaxing injections, or if their budget is small or if they want a more subtle result, then a smaller dose might be chosen.

In general, we recommend the higher dose treatment
Pain relief during treatment
A numbing cream (eg EMLA or LMX ) will be applied to the area prior to the treatment (45 minutes prior is ideal) Glad wrap may be used over the numbing cream to increase its effect.
Ice is always used to decrease pain and to reduce the risk of bruising.
Patients may use Penthrox for excessive sweating treatments
Nitrous oxide (Happy Gas) is available for use for injections for excessive sweating of the hands
What happens during the excessive hand sweating treatment itself?
EMLA can be applied to the underarm and covered with gladwrap for 45 mins prior to the procedure

The area will be cleaned with alcohol.
Ice will be applied to the area briefly before treatment
The doctor will inject multiple sites in the palm of the hand and along the fingers in a grid-like pattern. Then pressure with gauze will be applied.
The procedure itself takes less than 20 minutes.
How do I look afterwards?
Sometimes there is nothing to see. Sometimes there can be redness, small lumps, which can look like mild acne and usually resolve quite quickly.
Typical problems which can occur:
In general, treatment of  excessive sweating is very low risk.
Headache happens in around 10% of new users.
Bruising occurs in a significant number of cases.
Asymmetry: One side may be better treated than the other, this is usually because the patient has asymmetrical sweating to start with..
Infection is a very rare complication, but always a possibility when the needle goes into the skin.
There is a low risk of muscle strength being affected in the hands. This is important if the patient’s occupation could be affected (eg musician)

There is a possibility of a perceived increase in sweating in other areas of the body
Who is unsuitable for treatment of excessive sweating?
Most people with a excessive sweating are suitable for this treatment
Instructions for care afterward
No heavy exercise that day
What to expect after excessive sweating of underarms treatment?
The effect will not start to occur for 2-8 days.
The maximal effect of the drug will be at 3-4 weeks, so a review should be booked if required  for 4 weeks. If at that time, further treatment is necessary, it should be performed. The starch iodine test may be necessary
What if I get asymmetry of sweating or I am still sweating at some time before the 4 week point? Do I call the doctor?
No. No need to call the doctor. Sometimes asymmetry will occur because one side just comes on quicker than the other. Usually it will right itself by the time of the review appointment. If it doesn’t, then it can be treated at the review appointment. There is no point in coming in early for treatment of asymmetry.
What do I do if at 4 weeks post treatment one side is better treated than the other?
At your 4 week review appointment, this will be investigated and further treatment may be administered.
How long will the treatment last?
The answer to this is very individual and depends on the patient’s metabolism, the dose, the placement etc.
At a higher dose, some patients may get 8 months to 1 year out of the treatment.
At a smaller dose, re-treatment may be required several months earlier than above
When should I have my next treatment for excessive sweating
When the sweating recurs or at 1 year, whichever occurs first
How much does it cost for excessive sweating of the hands

$680-$1020 (The dosage of $1020 is suggested for most patients)

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