Terapi Art Fizik Tedavi Merkezi 1. Levent Funda Sok. No:5 Levent / İSTANBUL

Treatment of Hyperhidrosis

Underarm Sweating Botox Application

8 years ago, I have started to use water iontophoresis in the management of hyperhidrosis of the hands, foot and armpit, for the first time in Turkey. Iontophoresis is a reliable treatment modality without side effects and I used this method in 5000 patients who presented with excessive sweating in the hands, foot and armpits. This treatment may be used in patients over the age of 12 with 97% efficacy.

CAUSES OF HYPERHIDROSIS OF THE HANDS, FEET AND ARMPITS AND TREATMENT MODALITITES
Hyperhidrosis of the hands, foot and armpits is a condition that may have a significant negative impact on social life, in particular. Typically, no other health conditions underlie localized hyperhidrosis. However, before deciding on the absence of an underlying etiology, a number of characteristics should be defined, including the age of onset, whether or not hyperhidrosis has started in childhood, whether or not other members of the family suffer from the same condition, timing of excessive sweating during the day, whether or not it occurs during sleep, its association with stress, seasonal changes, co-existing symptoms. Furthermore, any potential underlying factor should be investigated by blood tests.

CAUSES OF LOCALIZED HYPERHIDROSIS: Localized hyperhidrosis is the result of overactivity of the sympathetic system. This system is a part of autonomic nervous system and become active during wakefulness. Therefore, localized hyperhidrosis does not occur during sleep. Sign and symptoms of localized hyperhidrosis (the hand, foot and armpits): • Feeling chilly due to wetness, sense of swelling, excessive sweating induced by passing from cold to warm environments, emotional stress and crowded environments •Soaking through clothing may disturb the appearance and may result in earlier deformation of clothing and shoes 2- Another disturbing symptoms is itching and malodor associated with fungal infections particularly in the foot, as moist areas of the skin are more prone to fungal infections.

Why does localized hyperhidrosis occur?
Localized hyperhidrosis is the result of the overactivity of the sympathetic system. This system is a part of autonomic nervous system and become active during wakefulness. Therefore, localized hyperhidrosis does not occur during sleep.

Causes of Generalized Hyperhidrosis:
The differentiation of generalized hyperhidrosis from localized hyperhidrosis is of paramount importance in terms of medical consequences. Localized hyperhidrosis that occurs after childhood, without any accompanying symptoms is usually constitutional and may be a genetic trait. However, hyperhidrosis needs to be medically investigated particularly when it occurs later in life. Generalized hyperhidrosis, night sweats in association with elevated body temperatures may suggest an underlying infection or tumoral condition.
• Overweight, diabetes, thyroid disorders, alcohol consumption, alcohol withdrawal.
• Psychiatric disorders, excessive nicotine consumption, caffeine
• Pregnancy, menopause, certain heart diseases, post-sympathectomy (i.e. surgical removal of sympathetic nerves), hypoglycemia
• Several neurological disorders, including Parkinson’s disease, spinal cord disorders

Treatment That We Administer in Hyperhidrosis:
Iontophoresis
Hyperhidrosis of the hand and foot: Water iontophoresis is a highly effective treatment modality and may be used as initial treatment based on the medical history and in the absence of any systemic symptoms or skin disorders. Although it has been an established treatment modality since long ago, this treatment modality has been widely used since the introduction of novel practical tools. This modality is 97% effective and a machine is used to generate linear flow to apply to the hands or feet immersed in water. The same machine has an apparatus to be used in the armpits. A session lasts for 30 minutes, and the treatment is painless and diminishes sweating after a total of 15 sessions given 5 times a week for 3 weeks. Then, the frequency of sessions is gradually decreased and the patient continues to receive treatment at the hospital until the frequency of sessions decreases to one session a week. The purpose of the treatment is to stop sweating during the time intervals of one week or 10 days between the sessions. This purpose is met after 15 to 20 sessions. At this point, patients have to continue their treatment and they can either purchase their own machine to be used home or visit the hospital at regular intervals. One session applied by the patient weekly will be constantly control sweating. The treatment is 97% effective. In other words, based on our experiences, this is the most effective treatment modality with less side-effect compared to other modalities.

What Is the Mechanism of Action: Although the mechanism of action is not completely understood, electrical flow is believed to cause a mild keratosis− a thickening invisible from outside− at skin openings of sweat glands or ion flow may have transient blocking effect on the function of secretory cells of sweat glands.

Axillary Hyperhidrosis: Iontophoresis is 60% effective in the treatment of axillary hyperhidrosis. Initial sessions should be supervised by a physician as the intensity of the flow should be adjusted and the treatment may cause skin problems. The patient may use the axillary apparatus of the same machine purchased to be used at home for hand and foot hyperhidrosis. This apparatus is an easy –to-use tool specifically designed to be used in the armpits. This treatment is also administered as sessions. Every session lasts for 20 minutes and the treatment program should be tailored to the needs of the patient, as recommended by the physician. BOTOX is another effective treatment to be used in axillary hyperhidrosis and is the treatment of choice in patients with isolated axillary hyperhidrosis. This treatment is administered as injections and its effects last for 9 to 12 months. Botox injections may provide a significant cosmetic relief. The use of Botox is contraindicated in:
• Pregnancy
• Patients with metallic orthopedic implants
• Patients with cardiac pacemaker

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