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Greenville News: It's NO SWEAT
From the Greenville News, by Mike Foley:
It's said that horses sweat, gentlemen perspire and ladies glow. Of course, none of them wants to do so excessively.
But that's exactly what occurs in about 3 percent of the population -- up to 9 million Americans, who suffer from hyperhidrosis, a condition that causes them to sweat excessively under normal circumstances. Now, some of them are finding relief in an unexpected treatment.
Count Judy Fulmer among those who've suffered from excess sweat. For most of her adult life, she's had to worry about staining or soaking her clothes.
"It's an embarrassing situation," the Easley resident said.
For most people with primary hyperhidrosis, overproductive sweating is localized in the underarms, hands and feet. While sweating is a normal bodily function that helps cool the surface of the skin and thereby regulate body temperature, studies show people with hyperhidrosis produce as much as five times as much sweat as normal.
A Constant Worry
For Lisa Ferrell, a Seneca resident, that's meant a lifetime of wearing dark clothing, constant worries and countless unsuccessful attempts to control her perspiration.
"I've had this for as long as I can remember," Ferrell said. "It's humiliating. I've tried deodorants, anti-perspirants, everything I could get my hands on. The improvements were so slight, they weren't even worth it."
"You can't even go to the grocery store. It's a little embarrassing when you can't raise your arms."
Hyperhidrosis remains something of a mystery. Its exact cause isn't known, but there appears to be a genetic link, said Lisa J. Pieretti, executive director of the International Hyperhidrosis Society, based in Philadelphia. Multiple generations often have a history of excessive sweating.
Cases vary from mild to severe, and people react differently to the condition.
"You and I might sweat the same," she said, "but I might be more sensitive to it."
Differences occur in gender, age, and even occupation. A person who does manual labor outdoors for a living, Pieretti said, might tolerate hyperhidrosis much better than a white-collar professional who's in constant contact with the public.
"Generally, people get this in adolescence," she said. "But the result of nobody knowing why it's caused is that you have all of these seemingly random types of treatments."
Revolutionized Treatment
One recent day, Ferrell lay on her back in Dr. William Drury's exam room with one arm raised over her head. Drury was dabbing polka dots on her underarms with an eyeliner pencil, marking spots to inject Botox. Approved in July 2004 to treat axillary, or underarm, hyperhidrosis, Botox has been touted as the latest and greatest treatment for the condition.
Pieretti calls Botox simply "fabulous."
"It works for underarms," she said, "it works for the hands, and it works for the feet."
Currently, the FDA has only approved Botox as a treatment for axillary hyperhidrosis. Other uses are considered "off-label," that is, there isn't sufficient evidence yet to prove their efficacy.
Nevertheless, Pieretti said, Botox has revolutionized treatment of hyperhidrosis.
"I think everyone is really waiting for a cure," she said. "I think that will occur in our lifetime, but it's going to be awhile."
In the meantime, Fulmer said she has been thrilled with the results of the Botox injections that she received in April.
"It only took 20 minutes," she said about the series of injections, "and I got immediate relief. I've never had the first bit of sweating."
She went from being a person who tried every deodorant on the market, even reapplying them through the day, to one who no longer has to use deodorant at all.
"I run three miles every morning and I don't sweat and I don't stink," she said. "I also work in my yard and garden all the time and nothing.
"It's just the most wonderful thing."
Botox is becoming the treatment of choice. While the idea of multiple injections seems painful, Ferrell didn't flinch as Drury slid a short, thin hypodermic needle into about 20 spots in her underarm.
With each shallow puncture, Drury injected small amounts of botulinum toxin type A -- a.k.a. Botox -- which blocks sympathetic nerve impulses and effectively prevents sweating at the area where it has been injected. Because these are sympathetic nerves, and not sensory nerves, there is no loss of sensation in the area that's injected.
Ferrell said the injections didn't hurt at all, and if her treatment goes well, she will probably recommend it to her 23-year-old daughter, who has the same condition.
"She's got it pretty bad on her feet," the 45-year-old said. "She likes to wear flip-flops, but she can't because her feet slide right out of them."
Drury was caught off-guard earlier this year by the sudden flood of patients interested in Botox treatments for the condition.
"Three people called in one day about hyperhidrosis," he said. "I guess Allergan (a Botox manufacturer) must have just started doing some advertising."
Intrigued, Drury said he did some investigation and then learned how to do the procedure. Since then, he's treated two men and about 10 women.
"The literature and the Botox Web site say to expect relief within four weeks," Drury said. "But all of my patients have said that within 24 hours they can tell the difference."
Treatment lasts anywhere from four to 12 months, Pieretti said, and maybe longer. One study she saw followed dozens of patients and stopped 14 months after their initial Botox treatment. None had needed re-injections at that point.
Both Drury and Pieretti said many insurance companies reimburse for Botox injections for the condition. Drury said in a typical treatment, he'll split a vial of Botox, putting half of a vial in each underarm and charge about $2,000.
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List your practice or search for colleagues. |
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