Excessive Sweating Treatment:

As a previous long time sufferer of excessive underarm sweating, I can relate to the embarrassment of staining clothes, being unable to wear certain color and types of clothes and the feeling of being damp all the time. The different ways to treat this in the past have been:
Antiperspirants: over the counter types never seem to do the job. Prescription antiperspirants, such as Drysol and Maxim seem to burn,  are very irritating and never work.
Anticholinergics: These are prescription medications such as Robinol and Ditropan. They work best in cases of people who have sweating in large areas of their body that cannot be treated with Botox, such as the scalp under the hair or the abdomen and back. Unfortunately, the dryness that they produce is very variable and is dose related. About 60% of people have complaints of very dry mouth that in some cases cannot be tolerated. Some other side effects are headaches, constipation, sleepiness, blurred vision and urinary retention. I sometimes combine a very low dose of Robinol with Botox injections to treat larger area of the body that include the underarms and hands.
Iontophoresis: This is used to treat the hands and feet mostly and uses a machine that sends a mild current of electricity to the skin. You need to use this machine for about 20 minutes 2-4 times per week and purchase the machine. The results of using this are mixed and very labor intensive.
Endoscopic Thoracic Sympathectomy: This technique involves a surgical procedure whereby, under general anesthesia, the surgeon places three small endoscopes into the chest wall and cuts, burns or clips the thoracic sympathetic ganglia at the T2 and T3 level for hand sweating and T4 for underarm sweating. The results of this show that about 90% obtain dryness of the hands when T2 and T3 are damaged, but only about 60% get dryness under the arms when T4 is added. The complications can be bleeding, requiring conversion to open thoracotomy, hemo-, pneumo- and chylothorax, pleural adhesions or effusion, peripheral nerve injury, chronic postoperative pain, complete or incomplete Horner’s syndrome. The most troubling complication is that of compensatory sweating in the back and abdomen that can be worse than the original problem. Almost all patients suffer some degree of compensatory sweaty, however the amount is unpredictable before the surgery. Once the surgery is performed, it is irreversible and the patient is left with whatever amount of compensatory sweating that results.
miraDry: This is a newly approved technique to treat only underarm sweating that uses electromagnetic energy to destroy the sweat glands. Long term follow up is not available at this time. The results are not as good when compared head to head to Botox and requires injections of anesthetic to prevent the burning sensation that the energy generates. (Full disclosure: I participated in the early clinical trials with some of my patients)


Click here to see NPR’s interview with Dr. Solomon’s Botox treatment


You can see the Modified Bier Block technique that I developed for numbing the hands to make the injections pain free on YouTube at http://youtu.be/msuSAkiK-9E



Bridges Medical Clinic
1320 El Capitan Drive, Suite 410
Danville, CA 94526
Tel: 925-975-3353
Fax: 925-820-2267