Hyperhidrosis, A Quick Guide to Treatment Options

Ron Myers
By Ron Myers

As an Aesthetic Business Coach and Mentor, Ron helps aesthetic clinics and suppliers to maximise their profits.

Hyperhidrosis (excessive sweating) affects an estimated 1 – 2% of the population and is a condition that causes anxiety, embarrassment and even depression.  The symptoms can occur all over the body or localised to specific areas, most frequently the hands, feet, underarms and groin.  The condition may be classified as either focal (primary) hyperhidrosis, which often begins in adolescence and may have a genetic component, or secondary hyperhidrosis, which can start at any age and may be due to a specific disorder or exposure to chemicals. 

Once diagnosed by a GP, the hyperhidrosis sufferer will normally progress through a pathway of treatment options, beginning with aluminium chloride-based antiperspirants. 

 

If these are found to be ineffective, or cause unpleasant side effects such as itching and irritation, the patient will usually be referred to a specialist dermatologist in the NHS.  Further treatment options can then be offered and tried, either within the NHS, in a private hospital or in an aesthetic clinic. 

Here is a quick guide to some of the treatments currently available to axillary hyperhidrosis sufferers, including an introduction to an exciting new option known as miraDry that has recently entered the UK market.

Iontophoresis

Iontophoresis is most commonly used for treating hyperhidrosis of the hands and feet; treating the axillae is not as straightforward.  The exact mechanism of action is unknown, but the hands or feet are placed in water and a small electrical current is passed through the skin. 

Iontophoresis provides only temporary relief from hyperhidrosis.  Treatment is administered every other day to begin with, then the frequency can be reduced to once a week; however, the symptoms will return if the regime is stopped.  The procedure is available in NHS hospitals but requires frequent outpatient visits.  Home kits can be purchased and the treatment is also offered by some aesthetic and medically-led clinics.

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Laser Sweat Ablation

Laser Sweat Ablation (LSA) has been pioneered in the UK by Dr Mark Whiteley.  LSA is performed on the axilla under local anaesthetic; two small incisions are made, the dermis is separated by the underlying subcutaneous fat and a laser fibre is inserted.  The laser is fired at the sweat glands, which are destroyed and removed by curettage. 

Although LSA is a successful and potentially permanent surgical treatment option for axillary hyperhidrosis, it has not been subjected to clinical testing and is not widely available in the UK at the present time. 

 

Surgery

The decision to have surgery to treat hyperhidrosis is a major one that requires very careful consideration, due to the potential for complications and side effects.  Endoscopic (or Video-assisted) Thoracic Sympathectomy (ETS) is the most common form of surgery, which is performed under a general anaesthetic and is used as a treatment for hyperhidrosis for all areas of the body, with the exception of the feet.  During the operation, the surgeon will insert a camera into the chest in order to identify the sympathetic chain, from which the sympathetic nerves that stimulate the sweat glands radiate.  Small areas of the sympathetic chain are destroyed, thereby removing the stimulation to the glands

ETS is carried out both in the NHS and at private hospitals.  Side effects include compensatory sweating, where sweating becomes worse in other areas of the body; this occurs in almost every patient, and in 1 in 20 patients is severe; some patients report that they regret having the operation.

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Botulinum Toxin

Today, many aesthetic clinics offer botulinum toxin injections for axillary hyperhidrosis (excessive underarm sweating), alongside treatment for wrinkles. Treatment is carried out within the NHS and in aesthetic and medically led clinics and has the benefits of rapid results with very few side effects, apart from some bleeding and bruising at injection sites.

In terms of efficacy, data suggests that a sweat reduction of 50% or more is observed in 80% of patients.  However, studies have found that it is only effective for an average of seven months, after which the procedure must be repeated.  This makes it an expensive option for the patient over the course of a lifetime.

miraDry – a new treatment for the UK market

A new option for axillary hyperhidrosis patients is now available in the UK, known as miraDry.  Developed in the USA, where is it now used in over 250 private clinics and medical centres, the miraDry procedure is the only FDA cleared treatment for axillary hyperhidrosis.  The procedure is pain-free, non-invasive and does not involve toxins.

The treatment works by delivering precisely controlled electromagnetic energy to the armpit, which penetrates to the location of the sweat glands.  The glands are thermally destroyed and the debris is naturally absorbed by the body.  Sweat glands do not regenerate, so the reduction in sweat achieved is both immediate and lasting.

In clinical tests, an average 82% reduction in sweat was achieved after the recommended two treatments, spaced three months apart.  Self-reported patient satisfaction levels are high, as measured on the review website Real Self, where it has achieved an excellent 92% rating based on 136 reviews.  Side effects include temporary swelling and bruising which usually resolve in a matter of weeks.  In addition, the procedure permanently reduces underarm hair, which is often viewed as a benefit, particularly by female patients.  Odour is also reduced due to the destruction of apocrine glands, along with the sweat glands, which is another benefit of the treatment.

 

The International Hyperhidrosis Society (IHHS), the only independent, non-profit hyperhidrosis support organisation that operates globally, has recently updated its axillary hyperhidrosis (excessive underarm sweating) treatment pathway.  The IHHS now places the use of microwave thermolysis (miraDry) as a second-line treatment option for physicians to recommend if their patients fail to respond to topical antiperspirant therapy.

This means that miraDry is now officially recognised by an international, independent body as an effective procedure and an excellent treatment option for people who suffer the inconvenience, anxiety and distress caused by excessive underarm sweat. 

miraDry is an exciting development in the field of hyperhidrosis and should be considered as a possible option for any clinic that is currently treating hyperhidrosis patients.  In contrast to toxin injections, miraDry provides a long lasting solution and is likely to permanently eliminate sweat glands.  When compared to LSA, which also destroys the sweat glands, miraDry has a clinical evidence base and FDA approval. 

Further information can be found at miraDry.co.uk.

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