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WASHINGTON, D.C., February 9 -- The excessive sweating condition known as hyperhidrosis can be a debilitating and life-inhibiting disorder if left untreated. Fortunately for patients with hyperhidrosis, dermatologists are successfully using several treatments -- including local injections of Botox (botulinum toxin) -- to prevent the pain of perspiration.

Speaking at the 62nd Annual Meeting of the American Academy of Dermatology (AAD), dermatologist Dee Anna Glaser, MD, Vice Chairman, Dermatology Department, Saint Louis University School of Medicine, St. Louis, Mo., discussed the safety and effectiveness of five hyperhidrosis treatments, ranging from botulinum toxin to surgery.
Medical condition, not cosmetic

Hyperhidrosis is a chronic medical disorder that results in the production of excessive sweat. A recent study determined that the condition -- once thought to be rare -- actually affects approximately 2.8 percent of the U.S. population, or 7.8 million people. Even more compelling, one out of three people surveyed with the condition said their sweating was intolerable or barely tolerable. Many sufferers said they were depressed and frustrated with daily activities, and they experienced interference with work and romance and had difficulty meeting people.

"It is important for people to realize that hyperhidrosis is not a mild nuisance that just a few people experience," said Dr. Glaser. "This is a big problem that does not get better without proper treatment and can really be debilitating for those affected by it."
No hiding it

Hyperhidrosis tends to first occur during the already difficult period of puberty and early adolescence. It causes much of its social, psychological, emotional, and physical impairments because of its conspicuous locations: on the palms, underarms, and soles of the feet. At the same time, the amount of sweat that is produced is often too difficult to conceal.

"Our studies have found that patients with hyperhidrosis produced four to five times the amount of sweat as those without the condition," said Dr. Glaser. "Men with hyperhidrosis, for example, produced an average of 346 milligrams of sweat per five minutes, as compared to men sweating normally, who produced 72 milligrams. Women with hyperhidrosis produced 186 milligrams of sweat, while normal women produced 46 milligrams."

Treatment options for hyperhidrosis are administered according to the site and severity of the symptoms and include:
Botulinum toxin

New research indicates that botulinum toxin -- the drug that paralyzes wrinkles for cosmetic purposes -- works to treat hyperhidrosis by interrupting the chemical messages released by nerve endings that tell the sweat gland when to sweat.

The study, to be released at the AAD's 62nd Annual Meeting, included 322 patients who were injected with either botulinum toxin or placebo. Among the individuals who received the botulinum toxin, 82 percent to 87 percent said they had significantly decreased amounts of sweating. By comparison, the same claim was made by only 33 percent of the patients who were treated with placebo. The average duration of botulinum toxin's benefits was approximately 200 days, and 85 percent of the patients treated reported satisfaction with botulinum toxin therapy compared with previous treatments.

"Dermatologists around the country who are using this new treatment are echoing the results of previously published papers, and they are very excited about the results that their patients are experiencing," said Dr. Glaser.

Dermatologists inject patients with botulinum toxin at the site where the excessive sweating is occurring, such as the hand or underarm. The drug promptly freezes the nerve that would normally stimulate the sweat gland. For maximum results, injections may need to be repeated every six to nine months.
Topical agents

Prescription antiperspirant products are also an option for patients to control excessive sweating on their hands and feet, as well as their underarms. Highly-potent topical antiperspirants that contain 12 percent or 20 percent aluminum chloride have been found to work well for some patients. While these products are best used at night on dry skin, patients can bathe in the morning without having to reapply the medication. A common side effect reported by patients who use these powerful antiperspirants is skin irritation.
Systemic agents

Anticholinergics, a class of medicine that calms muscle spasms and includes drugs for depression, anxiety, and nervousness, can be taken orally to prevent sweat gland stimulation in some patients. Pills such as glycopyrrolate can be very effective in doses of 1 mg to 2 mg, taken two to three times a day. Common side effects that limit the use of this drug include overheating, blurry vision and drowsiness. In addition, glycopyrrolate may exacerbate certain urinary, gastrointestinal or cardiac problems.

"Since there can be quite a few side effects, the overall health of the patient really needs to be taken into consideration before anticholinergic medications are prescribed," said Dr. Glaser. "Even then, patients need to report any unusual problems they experience while taking this medication to their dermatologist immediately."
Iontophoresis

Iontophoresis is a procedure in which water conducts an electrical current from an electronic device through the skin's surface, thus inhibiting sweat production. The technique has been used successfully since the 1950s, and studies indicate that 83 percent of people treated with tap water iontophoresis respond well. After a series of treatments, patients may need one maintenance treatment every one to four weeks to keep hyperhidrosis under control.
Surgery

Two types of surgery interrupt sweat production: sweat gland resection and endoscopic transthoracic sympathectomy (ETS). Resection involves the actual removal of sweat glands while ETS involves clipping the nerves that carry the messages to the sweat glands.

"At one time, ETS was considered a major operation, but today the surgery is less invasive and highly effective for some people," said Dr. Glaser.

Patients who think they might have hyperhidrosis should consult a dermatologist to diagnose the problem and determine the best course of treatment. "It is unnecessary for people to suffer through life without the benefit of treatment," noted Dr. Glaser. "Only about 38 percent of the people surveyed in the 2003 study said they had ever discussed their sweating problems with a doctor. Unfortunately, sweating implies something unclean about yourself. There are a lot of anxiety-induced feelings about it."

Source: American Academy of Dermatology www.aad.org

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