sweating

For some, summer weather brings more than swimming and sunbathing. For three percent of Americans, the warm weather months are the peak season for excessive sweating, clinically known as hyperhidrosis. While the condition is present year-round, hotter temperatures are — unsurprisingly — a major trigger. So, what are the best ways to stay dry as the mercury rises? The AEDITION asked the experts.

## **What Is Hyperhidrosis?**
We all sweat. It’s the body’s way of keeping itself cool. But, for a small percentage of the population, excessive sweating (a.k.a. hyperhidrosis) can have a serious impact on a patient’s quality of life. There are two main types of hyperhidrosis: 

1. **Generalized Hyperhidrosis**: Affects the entire body (including the face)
2. **Localized Hyperhidrosis**: Focused to areas like the underarms, palms, and soles

The condition affects men and women equally, and the majority of hyperhidrosis patients (think: 60 to 80 percent) have a family history. Excessive sweating generally presents equally on both sides of the body and subsides during sleeping hours. 

## **Hyperhidrosis Triggers**
Like regular sweating, hyperhidrosis can be brought on by a variety of factors. “Common triggers include hot weather, anxiety, exercise, and spicy foods,” says Tatyana Nektalova, MD, a board certified dermatologist at [Spring Street Dermatology](https://springstderm.com/) in New York City. “It may also be caused by chronic medical conditions such as nerve damage and a hyperactive thyroid.” 

The condition begins during the teenage years, which can make it particularly damaging to self-confidence at a critical age. For many patients, hyperhidrosis is more than just a nuisance. Excessive perspiration can damage everything from clothing to relationships. When the condition affects quality of life, many seek medical intervention.

Fortunately, there are several treatment options for excessive sweating — and some of the more recent innovations offer longer term relief.

## **Traditional Treatments for Hyperhidrosis** 
Tried-and-true treatment options for hyperhidrosis include prescription-strength antiperspirants, electrical currents, and oral and topical anticholinergic medications that our experts say offer suitable relief for many patients. 

### **1. Antiperspirants** 
“The most common treatment for hyperhidrosis is using topical antiperspirants, which use aluminum salts to block the sweat ducts,” says [Samer Jaber, MD](https://aedit.com/provider/samer-jaber-md-3882), a board certified dermatologist and founder of [Washington Square Dermatology](http://www.washingtonsqderm.com/) in New York City. Prescription antiperspirants contain a higher level of aluminum than over-the-counter products, which can sometimes lead to skin irritation, he says. Despite speculation connecting aluminum antiperspirant use to breast cancer, no studies have proven a correlation.

### **2. Electrical Current**
According to Dr. Nektalova, iontophoresis is another treatment option for hyperhidrosis patients. The iontophoresis device uses an electric current to disrupt the connection between the nerves and the sweat glands. While the treatment has been shown to be very effective in many patients, ongoing maintenance sessions are required.

### **3. Oral Medication**
Anticholinergics (i.e. substances that block the action of a neurotransmitter called acetylcholine, inhibiting the nerve impulses responsible for sweating) have long provided relief for excessive sweating. “Oral anticholinergic medications can be very effective, but can have side effects like dry eyes or dry mouth,” Dr. Jaber says. But a new format seeks to solve that.  “A new topical anticholinergic towelette was recently FDA approved and can be really effective for the underarms,” he notes. 

## **Innovations in Hyperhidrosis Treatments**
For those looking for longer term treatment options, professional procedures like Botox® and miraDry® offer promising results for both hyperhidrosis patients and those who simply wish to thwart sweating.

### **4. Botox® Injections**
Botox® injections have been approved by the United States Food and Drug Administration (FDA) for the [treatment of primary axillary hyperhidrosis](https://aedit.com/procedure/botox-for-hyperhidrosis) (a.k.a. excessive armpit sweat) since 2004, and practitioners often use it off-label to treat the palms of the hands and soles of the feet as well. “Neuromodulators work by temporarily blocking the release of the neurotransmitter acetylcholine, which prevents eccrine glands from sweating,” Dr. Jaber explains. He says neuromodulators are a great option for patients who “try and fail” with conventional treatments.

Susanna, a physician assistant in Dr. Jaber's office, has been receiving armpit Botox® treatments for years. “Botox® in my underarms has been life changing,” she shares. Calling it “by far the most effective treatment” she has tried for her localized hyperhidrosis, Susanna says regular Botox® injections have improved her quality of life. “People without this issue don’t realize how much it really gets in the way of daily life,” she says. “It is amazing to not have to worry so much about what I’m wearing or pick out the best stain-proof clothes when shopping. I can reach for something in a cupboard without watching to make sure people aren’t looking — just in case I have stains under my arms.” 

Dr. Sean, a plastic surgery resident, has had a similar experience. “I’ve always been the person to have a sweat stain when I go out,” he shares. “I’d tried prescription-strength antiperspirants and used powder, but the stain was still pretty noticeable.” Getting Botox® injections has been a game changer, though routine maintenance is required. “I get it seasonally — right around Memorial Day — or before a trip or special event,” he says. “It takes about a week to kick in. By the two week mark, I notice it’s pretty dry, and I don’t have to worry about deodorant then.” Despite the benefits, he cautions against using Botox® too often. “There's a risk of developing antibodies to Botox®, so you don’t want to use it too often,” he says. “It could potentially never work again.”

Something else to keep in mind? The price tag. This sweat stopper doesn’t come cheap. Underarm Botox® will set you back about $1,000 for both armpits — though it is sometimes covered by insurance. The effects typically last between three and six months depending on how fast you metabolize botulinum toxin type A (the active ingredient in Botox®). The procedure itself is usually described as mildly painful. “It’s like a bunch of mosquito bites,” Dr. Sean says. According to Susanna, numbing cream can make it more tolerable. Side effects include minor bruising and swelling at the injection site and, rarely, allergic reaction.

It should be noted that Botox® injections under the arms, on the palms, and on the soles of the feet are also favored by patients who might not technically have hyperhidrosis but are tired of sweating through their shirts or putting forth a soggy handshake. Chrissy Teigen is one such fan. Last summer, [she took to social media to share her Botox® experience](https://aedit.com/aedition/armpit-botox-to-treat-excessive-sweating-hyperhidrosis) and rejoiced in her ability to “wear silk again without soaking.”

### **5. miraDry®**
[MiraDry®](https://www.miradry.com/) was approved by the FDA in 2011 to treat excessive underarm sweating. “MiraDry® offers the majority of patients a permanent reduction in sweating after two treatment sessions,” Dr. Nektalova says. “The treatment uses microwave energy to destroy the sweat glands that produce both perspiration and odor.”

Although many patients notice a difference after one treatment (which typically takes about an hour — between numbing and device application), optimal results generally require two sessions. Due to the use of lidocaine, getting miraDry® isn’t painful. Patients may, however, experience mild discomfort for a few weeks afterward. As Dr. Nektalova explains, the most common side effects of miraDry® are bruising, swelling, tenderness, and variable underarm hair reduction. 

The average cost of miraDry® is $2,000 to $3,000 per session, and the procedure is not covered by insurance. Patients who can afford the price tag say it’s well worth the expense. “I tried Botox® several times and miraDry® twice,” says Janine*, a patient of Dr. Nektalova. While the initial cost associated with miraDry® may be higher, it does not come with the same upkeep as Botox® injections. “Botox® used to be great, but it only works for a short while,” Janine says. “MiraDry® has reduced my sweating dramatically.” Oh, and there is another added benefit. “It got rid of my armpit hair,” she shares.

Like Botox® injections, miraDry® is also used by non-hyperhidrosis patients who wish to reduce underarm sweating.

## **The Takeaway**
If excessive sweating is impacting your quality of life, it is time to talk to a dermatologist. With the array of treatment options available, chances are they can help reduce your pesky perspiration.

*Patient’s name has been changed

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The warm weather months are the peak season for excessive sweating (a.k.a. hyperhidrosis). What are the best ways to stay dry as the mercury rises? The AEDITION asked the experts.

Hyperhidrosis And Excessive Sweating Treatments: Botox, miraDry, And More

Never Let Them See You Sweat: 5 Treatments For Hyperhidrosis

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We can always count on Chrissy Teigen to be candid on social media, so it should come as no surprise that the cookbook author documented her recent trip to the plastic surgeon [on her Instagram Story](https://www.instagram.com/chrissyteigen/?hl=en) for her 25 million followers to see. The model paid a visit to Jason Diamond, MD, a facial plastic surgeon in Beverly Hills, for [Botox®](https://aedit.com/procedure/botox-facial), which, on its own, may not seem particularly newsworthy. But it's where she got the injections that piqued people's interest. 

![Screen Shot 2019-08-15 at 1.59.23 PM](//images.ctfassets.net/zw35sfestf1t/6tdrAjB73rjk81Fe1nlEPl/62bfef6e462af3eacf9b78781d3daa40/Screen_Shot_2019-08-15_at_1_59_23_PM.png)

"Botoxed my armpits," Teigen captioned a video of the procedure (*screenshot above*). "Truly the best move I have ever made."

While botulinum toxin type A (BoNT) injectables are best known for their anti-aging benefits (think: reducing the appearance of frown lines, forehead wrinkles, and crow's feet), [Botox®](https://aedit.com/procedure/botox-for-hyperhidrosis), in particular, was approved by the U.S. Food and Drug Administration (FDA) in 2004 to treat hyperhidrosis (a.k.a. excessive sweating). And it is used to treat patients with less serious cases, too. 

“Botox® in the underarms is a very popular treatment to decrease sweating,” says [Samer Jaber, MD](https://aedit.com/provider/samer-jaber-md-3882), founder of Washington Square Dermatology in New York City and assistant clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai. “Hyperhidrosis affects approximately 2 percent of the U.S. population. In many patients, it can interfere with the quality of their lives and increase social anxiety.”

To be clear, some amount of sweating is necessary to regulate body temperature, but Botox® is an option for patients who do not respond to antiperspirants and/or find their quality of life impacted by sweat. 

“It can significantly minimize sweating of the underarms, which is a goal for many people who want to avoid social embarrassment or staining their clothes,” Dr. Jaber says of the treatment. “I also do this procedure for many of my patients who don't have excess sweating but want to avoid sweat marks for a major event such as a wedding, party, or important work presentation.”

The BoNT injections work by temporarily blocking the release of the neurotransmitter (acetylcholine) that activates the sweat glands. As a result, the body stops sweating (or sweats significantly less) in the area the Botox® has been injected. And, while the FDA approval only extends to the underarms, it is also employed "off label" on other parts of the body. Dr. Jaber says it is often used “on the palms and soles” or even to treat “a sweaty forehead or nose.” 

According to the [International Hyperhidrosis Society](https://www.sweathelp.org/hyperhidrosis-treatments/botox.html), BoNT injections have been shown to decrease sweating by 82 to 87 percent, with results kicking in anywhere from two days to two weeks after treatment. Dr. Jaber says his patients typically experience relief for four to six months, though it can last up to a year for some. 

But what about the rumors you may have heard that the sweat prohibited via Botox® in one area (think: the armpits) just manifests somewhere else on the body instead (say, the chest or back)? Dr. Jaber says it’s rarely a concern. 

“Sweating in other areas, or compensatory sweating, is a complication of endoscopic thoracic sympathectomy — a surgical procedure for those suffering from severe hyperhidrosis, where the nerves stimulating sweating are cut,” he says. “This is very rare with Botox® injections.”

During Teigen’s Instagram clip, Dr. Diamond appears to make about a dozen injections in a grid pattern under her arm with a single syringe. The entire process seemed to last no more than a few minutes, and the model remarked that it "really isn't anything."

Dosage and pain level depend on the area that is being treated and the severity of the condition, but Botox® for two armpits tends to cost around $1,000 and may or may not be covered by insurance. Bruising and pain at the injection site are common side effects in the days following the procedure (Dr. Jaber says the discomfort tends to clear up quickly), and, in rare cases, patients may experience botulism-like symptoms (severe muscle weakness, difficulty breathing, etc.).

But for Teigen and others who deal with excessive sweating, the promise of prolonged dryness is more than worth it.

"I can wear silk again without soaking,” she concluded. “Woohoo!" 

Chrissy Teigen shared her trip to the plastic surgeon for underarm Botox® on social media and rejoiced in her ability to “wear silk again without soaking.” So, what’s the deal with the sweat-reducing treatment? The AEDITION breaks it down.