Posts Tagged ‘Topical Agents’
Excessive Underarm Sweating
Excessive underarm sweating, or known in medical literature as primary axillary hyperhidrosis is one of the most common types of hyperhidrosis (excessive sweating).
Sweating is a natural response of the body to regulate its internal temperature. Sweating happens when the body is exposed to a warm environment, when one is engaged in physical activity, and when anxious or stressed. But excessive sweating for no apparent reason can be embarrassing. In the case of axillary hyperhidrosis, underarm sweat leaves a visible stain on clothes, and often, the underarms are damp and sticky.
There are two types of glands found in the armpit area – the apocrine and eccrine glands. Of the two, the eccrine glands are the ones mostly responsible for producing underarm sweat. Numerous eccrine glands are also found in the entire body, which likewise cause perspiration when the glands are stimulated. Whenever the eccrine glands are stimulated to produce sweat, body cells secrete a fluid that travels the coiled portion of the gland up through the straight duct before it breaks out onto the skin surface.
If you suffer from excessive underarm sweating, a dermatologist can best diagnose the severity of your condition. Be ready to discuss with your dermatologist your medical background, your family’s medical history, and when you first experienced severe underarm sweating. Don’t hesitate to tell your dermatologist how your condition affects you. The extent to which severe hyperhidrosis is affecting your normal day-to-day activities can be measured through a self-assessment questionnaire called Hyperhidrosis Disease Severity Scale (HDSS). Your honest self-assessment report should help your doctor determine the best options available for you.
In most cases, excessive underarm sweating can be effectively managed by using topical agents such as deodorants and antiperspirants. Deodorants act to control bad odor, while antiperspirants slow down the production of sweat by the glands in the armpit area.
The most common active ingredient in anti-perspirants (and deodorants) is aluminum chloride. According to Dr. Eric Hanson of the University of North Carolina’s Department of Dermatology, the aluminum ions (from antiperspirants) are absorbed by the cell linings of the eccrine gland ducts found at the opening of the top skin layer (epidermis). These ions are drawn into the cell along with water until it swells, squeezing the ducts closed such that sweat can’t pass out. A cell can only absorb so much fluid, or until it reaches its equilibrium. At this time, the water will have to revert back out of the cell through a process called osmosis, and swelling will subside. When this happens, anti-perspirants may be re-applied.
As a point of reference, over-the-counter antiperspirants usually have 10 to 25% concentration of the active ingredient (aluminum chloride). While the FDA requires no more than 15 to 25% of the active ingredient in antiperspirants, it should decrease sweating by at least 20%. Obviously, no prescription topical agents or antiperspirants are available in the market that has a higher percentage of concentration of the active ingredient than that allowed by the FDA. It is still best to discuss other alternative treatments available with your doctor if over-the-counter antiperspirants prove ineffective for you.
Some people who excessively sweat may need higher concentrations of aluminum chloride to prolong the swelling of the cells and eventually shrink the sweat glands so that they don’t produce sweat than is really necessary.
Hyperhidrosis Treatment
Treatment choices that are offered to people suffering from primary hyperhidrosis can be classified into two treatments: Non-surgical (topical antiperspirants, iontophoresis, systemic medication) treatment and surgical (endoscopic thoracic sympathectomy, excision of axillary tissue) treatment.
Botulinum toxin injection is supposed to be minimally invasive and has become an accepted therapy for patients who do not react favorably to more conventional forms of treatment. This treatment therapy is normally done prior to resorting to surgery. Different therapeutic alternatives also vary in their length of efficacy. Side effects and response speed differ depending on the anatomic area treated. Topical therapy for focal hyperhidrosis or generally called antiperspirant treatment can be carried out with chemicals of several different classes. These classes comprise of astringent agents, topical anticholinergics, local anesthetics, and aluminum and other metallic salt solutions.
Most of the population in developed countries uses easily available over the counter antiperspirants for cosmetic and hygienic control of underarm sweating and odor. Individuals suffering from moderate to severe hyperhidrosis on the other hand require stronger remedies. Prescription medication and specially compounded solutions are commonly required for hyperhidrosis sufferers. Unfortunately these cures do not always give the desired effect.
Various topical agents analyzed are not easily obtainable commercially or do not have United States Food and Drug Administration endorsement and approval for the cure of hyperhidrosis. Only aluminum chloride has the approval of the USFDA for hyperhidrosis treatment. The preliminary treatment usually made for hyperhidrosis is normally non-invasive and does not necessitate any surgical procedure. There are commercially available ointments and salves (i.e., Drysol) that work as astringents and they have a tendency to dry up the sweat glands.
On the other hand, a different and acceptable cure for hyperhidrosis is iontopheresis. This is a hyperhidrosis treatment wherein electrical stimulation is used to lessen sweating. This procedure is normally done on the hands. Patients put their hands in a bath or basin of water wherein an electrical current is passed. This procedure stuns the sweat glands and tends to decrease the secretion of sweat for periods ranging from six hours to about 7 days.
One of the latest cures offered for hyperhidrosis is the injection of botulinum toxin or more commonly known as Botox. It is injected into the area where excessive sweating is experienced. This is a toxin that affects and sort of paralyzes the nerve endings. This toxin eventually reduces the transmission of the nerve impulses to the sweat glands which in turn results to reduce perspiration. It would normally require quite a few injections in the palms of the hands or armpits to complete the procedure. The effect of the procedure is observed to range from 1 month to 6 months. Continual injections are practically needed to sustain an acceptable level of dryness.
Besides the above-mentioned treatments, many drugs and remedies have been used with varying degrees of success. These include sedatives (for patients with stress induced hyperhidrosis) and medications that have an effect on our central nervous system. A family practitioner or internist is usually the one who makes the diagnosis and initial treatment for hyperhidrosis. Hyperhidrosis cases that do not respond accordingly to simple treatment regimens are often referred to a specialist such as a dermatologist or neurologist. As a rule of thumb, surgery is only considered when the less invasive medical treatments have been exhausted.


