Hyperhidrosis

No Sweat Ron Myers on a new non-surgical procedure for axillary hyperhidrosis offers a different treatment solution for sufferersHyperhidrosis (excessive sweating) affects an estimated 1-2% of the population and is acondition that causes anxiety, embarrassment and even depression. The symptoms can occurall 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 mayhave a genetic component, or secondary hyperhidrosis,which can start at any age and may be due to a specificdisorder or exposure to chemicals. Complications relatedto the condition include repeated skin infections andbody odour, which further exasperate the social problemssufferers may already be experiencing. 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 unpleasantside effects such as itching and irritation, the patient willusually be referred to a specialist dermatologist in the NHS. Further treatment options can then be offered and tried, either within the NHS or in a private medical aesthetic clinic.Here we review some of the treatments currentlyavailable to axillary hyperhidrosis sufferers and examinean exciting new option known asmiraDry that has recently enteredthe UK market.

BOTULINUM TOXIN

Botulinum toxin type A was licensed to treat axillaryhyperhidrosis in 2001.The toxin is injectedat multiple sites in thearmpit, where it acts byblocking the sympatheticnerves that stimulatethe sweat glands, therebyrendering them inactive. This treatment is carried out within the NHS and in private clinics and has the benefits ofrapid results, usually takingeffect within a week and producing very few sideeffects, apart from somebleeding and bruisingat injections sites. Interms of efficacy, data suggests that a sweat reduction of50% or more is observed in 81% of patients. However, thetreatment is only effective for about four to six months,after which the procedure must be repeated. Some NHS PCTs will not fund botulinum toxin treatments for hyperhidrosis. Private clinics charge in the region of£450 - £500 to treat both armpits, so it is quite possible foran individual to have an ongoing commitment to spending£1000 every year.

IONTOPHORESIS

Iontophoresis is most commonly used for treating hyperhidrosis of the hands andfeet and the exact mechanism of action isunknown. The hands or feet are placedin water and a small electrical current is passed through the skin. Treatingthe axillae is not as straightforward,although it can be done by placing water soaked pads and electrodesunder the arms. Iontophoresis provides only temporary relief from hyperhidrosis.Treatment is administered everyother day to begin with, then thefrequency can be reduced to once a week,or less frequently; however, the symptomswill return if the regime is stopped. Theprocedure is available in NHS hospitals, but requires frequent outpatient visits. Home kits can bepurchased for £350 to £500.

LASER SWEAT ABLATION

Laser Sweat Ablation (LSA) was developed in the UK by Professor Mark Whiteley from a technique used in BuenosAries in the late 1990s. LSA is performed on the axilla underlocal anaesthetic; two small incisions are made, the dermis is separated by the underlying subcutaneous fat and a laserfibre is inserted. The laser is fired in the region of the sweatglands, which are destroyed and removed by curettage. Although LSA is a successful and potentially permanent surgical treatment option for axillary hyperhidrosis, it isconsidered to be an experimental procedure and is notwidely available in the UK.

ETS SURGERY

Having surgery to control hyperhidrosis is usually a treatment of last resort. The most frequently performedprocedure is Endoscopic (or video-assisted) Thoracic Sympathectomy (ETS), which is performed under a general anaesthetic and is used as a treatment for hyperhidrosisfor 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, fromwhich the sympathetic nerves that stimulate the sweatglands radiate. Small areas of the sympathetic chain aredestroyed, thereby removing the stimulation to the glandsETS is carried out both in the NHS and at private clinics;patients who are treated privately can expect to pay around£5,000. Although the treatment is moderately successful,the side effects may outweigh any benefits. In particular,compensatory sweating, where sweating becomes worsein other areas of the body, will occur in many patients, and in one in 20 patients is severe with some reporting thatthey regret having the operation.

MIRADRY – A NEW TREATMENT FOR THE UK MARKET

In recent months, a new non-invasive treatment hasbecome available in the UK, known as miraDry. Developed inthe USA, where is it now used in over 250 private clinics andmedical centres, the miraDry procedure is FDA approvedfor the treatment of axillary hyperhidrosis.The treatment works by delivering preciselycontrolled electromagnetic energy to the armpit, which penetrates tothe location of the sweat glands. The process is painless as local anaesthetic is given before treatment and the miraDryhandpiece cools the dermis asthe energy is delivered. Theglands are thermally destroyedand then naturally absorbed bythe body. Sweat glands do not regenerate, so the reduction in sweat achieved is both immediateand lasting. In clinical trials, an average 82% reduction in sweat was achieved after therecommended two treatments, spaced threemonths apart. Self-reported patient satisfactionlevels are high, as measured on the US review websiteRealself.com, where it has achieved an excellent 92%rating based on 136 reviews. Side effects include temporaryswelling and bruising which usually resolves in a matter ofweeks. Interestingly, the procedure produces a reductionin underarm hair, which is often viewed as a benefit,particularly by female patients. Odour is also reduced dueto the destruction of apocrine glands, along with the sweatglands, which is an additional benefit of the treatment.miraDry is an exciting development in the field ofhyperhidrosis; in contrast to botulinum toxin injections, thetreatment lasts at least two years (on currently availableresults) and is likely to be a permanent solution to thecondition. When compared to LSA, which also destroysthe sweat glands, miraDry is less invasive, has a clinicalevidence base and FDA approval. In summary, miraDry sits within the medical aesthetic market between the extremes of temporary toxintreatments and the last resort procedure of surgery, andbrings real hope to hyperhidrosis sufferers. For clinics thatalready treat the condition, miraDry offersa unique, proven, long term and noninvasivesolution for patients withaxillary hyperhidrosis.

Author Biography

Ron Myers is a director of TheConsutling Room, AestheticBusiness Services, MediZenLtd and FACE Media Ltd. In 2002he set up a specialist consultancyservice with business partner Martyn Roe and hasworked on a variety of high profile business andmarketing projects in the aesthetic industry.