Excessive Sweating at A Glance
- Best Results1 treatment
- Treatment RecoveryNil
- Procedure Time3 minutes
- Skin SpecialistDavin Lim
- Duration of Results6+ months
- AnaestheticNot required
- Back to WorkImmediately
- Cost$ Medicare
Excessive Sweating- Hyperhidrosis
Hyperhidrosis is the term we use for excessive sweating. It affects up to 5% of Brisbane’s population. The most frequently treated areas are the underarms or axillary hyperhidrosis, followed by the hands & feet. Medicare & the PBS provides subsidised treatments for excessive underarm sweating.
FactsFacts on Hyperhidrosis or Excessive Sweating
- The most common areas for excessive sweating are the underarms- this is called axillary hyperhidrosis
- Underarm sweating can be effectively treated with anti- sweat injections
- This treatment can last up to 6 months or beyond
- Treatments are subsidised by Medicare and the PBS and cost less than $2 a day
- Sweaty hands can be treated with creams, iontophoresis & surgery
How common is hyperhidrosis?
Excessive sweating is very common- 3% of Brisbane’s population will have excessive underarm sweating, whilst another 2% will have sweaty hands & feet. A further 3% will have mild to moderate excessive sweating of the nose, forehead and scalp.
HH or hyperhidrosis can be genetic, one in four patients will have a family member that has excessive sweating.
Why does excessive sweating occur?
The cause of hyperhidrosis is genetic, made worse with stress, drugs & excessive caffeine intake. This type of sweating is called primary idiopathic HH or hyperhidrosis.
- It stops in your sleep.
- Re-commences upon awakening.
- Often runs in families (1in 4)
Treatments are available for different forms of HH, including sweaty hands, feet, underarms, face, and scalp areas.
Stress plays a huge part in many sweat patterns. I often work in with a psychologist to help patients manage stress, and in turn break the stress-sweat-stress- sweat cycle.
How do I know if I need treatments for my excessive sweating?
If sweating bothers you get help. A good way to know the impact of excessive sweating on your life is to ask two questions-
- Does sweating affect your work, either at school or the work place
- Does sweating affect you socially- are you embarrassed about sweat marks on your shirt, or shaking hands? Does it stop you from lifting your arms above your waist? Do you always wear black?
What can be done to reduce excessive underarm sweating?
Underarm sweating can be ranked from mild thru to very severe.
Mild cases respond to over-the-counter preps at your local pharmacy. Try the following for mild cases-
- Over the counter antiperspirants. Rexona Sport and Dove Clinical. Next up is aluminium chloride hexahydrate. This is very strong and can cause skin irritation. Make you’re your follow the instructions on the back of the box.
- Botox injections. This is very effective and works in 96% of cases. Patients will receive at least 70% improvement, and some up to 100% improvement in sweating. This treatment is covered by Medicare & works out to be less than $2 a day. All injections are performed by Dr Davin Lim (me). Medicare rules means you have go to try to control your sweating before Botox, this means a trial of aluminium chloride antiperspirant, Sesderma is a good brand.
- Some tablets can help with underarm HH or excessive sweating. These can be prescribed by your local doctor. (Anticholinergics). Ask your GP for oxybutynin or propantheline bromide. I do not prescribe tablets for sweating as this required close follow-up & titration.
- Endoscopic surgery can help with sweaty hands & underarms. This procedure is performed by a vascular surgeon.
- miraDry is a procedure is only suited to patient who want a reduction, and not a complete stoppage of sweating. 2 treatments are needed, 2-3 months apart. Expect sweating to be reduced by 75%. I do not perform this procedure nowadays due to the high incidence of nerve damage. In my experience, endoscopic surgery is far safer with a higher success rate.
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How can injections help with underarm sweating?
Botox or Botulinum Toxin Type A is a Specialist only treatment for excessive underarm sweating. By having this procedure performed by a recognised HH or hyperhidrosis specialist, you are entitled to a Medicare & PBS rebates.
Botox works by blocking the nerves that transmit the signal to sweat. Here are some facts on the treatment-
- This treatment takes less than 3 minutes to perform
- On average patients will have 96% less sweating for up to 6 months
- Most first time Botox patients will only get relief of up to 4 months
- Medicare approves 3 treatments per year
- On average the cost is less than $2 a day – this equates to around $440 per treatment
- This treatment is very safe
- You must try Aluminium Chloride (Drichlor or Sesderma) before Botox this is Australia’s Medicare rules. If Driclor causes irritation or does not work, you will qualify for the rebate. In 2020 the stocks of Driclor were low, speak to your pharmacist for an equivalent formulation
- Specialist treatment of underarm sweating saves you up to $2000 per year, as compared to cosmetic GPs performing this procedure.
Do anti-sweat underarm injections hurt?
Each injection feels like an ant bite, however the majority of patients can and will tolerate this procedure. For patients who want a painless procedure, numbing cream can be applied prior to injections. For super sensitive patients I can use ICE or a skin cooler.
Is there a permanent solution for underarm sweating?
Yes. It is called miraDry. I was the very first doctor in Australia trained in this procedure- back in 2014. miraDry treatment is only suited for excessive underarm sweating and provides a permanent solution for axillary HH. Fast forward 5 years, & I am not a fan of this treatment, purely based upon the side effects of nerve damage.
Lean patients with very little fat are especially prone to nerve damage. Your nerves that supply primarily sensation to your hands lie 3-9 mm under your sweat glands in the armpit. Microwave energy from MiraDry causes too much collateral damage. Neuropraxia often lasts 6 months or longer.
What can be done for sweaty hands?
Botox is not the answer unless you have overseas health insurance. Why? Botox is subsidised for sweaty armpits but not for hands. This treatment cost over $2500 every 3 to 5 months.
The safest treatment is called Glyco Ionto. This uses a special solution called glycopyrrolate that is transferred to your sweat glands using iontophoresis- a highly specialised machine. This sorts out 80-90% of sweaty hands and feet.
Glyco-ionto uses a special machine to deliver a chemical that stops sweating for up to 6 days. See Emily Fenton, nurse practitioner at Skinfluence in the Bayside area for this treatment.
What can be done for sweaty faces, and scalps?
Botox- this is the best solution however, it is not under Medicare for facial areas. Botox last 3-4 months and can only be done on certain areas of the face such as the nose, upper forehead, scalp & under the eyes. The scalp can also respond nicely to Botox injections. Treatment costs vary depending on the areas treated. An approximate guide is between $700- $1800 dollars.
No, I can not pretend to inject it into your armpit & use the rest for your face.
How do I make a booking to get my sweating sorted?
This depends on the sweat areas-
- For sweaty hands and feet, as well as sweat areas on your body, you are best seen in a public hospital as they have iontophoresis devices.
- For sweaty underarms, the treatment of choice is either Botox or ETS- I suggest treatment with Botox first because it is subsidised, and if you are lucky, it may last 8-12 months. For a vascular surgical opinion, Dr Andrew Cartmill in Brisbane is a good choice. If you would like miraDry, the best specialist is Assoc/Prof Phil Bekhor in Melbourne.
- Call up Clinic Cutis to make a booking with myself for underarm injections. Please note, as per Medicare guidelines, you will require Driclor or equal prior to injections.
What is the cost of anti-sweat treatment, and why are we cheaper than cosmetic clinics?
Botox injections performed by Specialists in the management of axillary or underarm sweating are partially covered by Medicare. This means patients can claim treatments. The out of pocket cost for treatment is $440. Considering the average user will be sweat free for six to eight months, treatment averages to around $2 a day.
miraDry treatments are not subsidised by Medicare, nor are they subsidised by private health insurance. This treatment course cost $3700.
How experienced is Dr Davin Lim in treating excessive sweating?
Dr Lim was one of Australia’s first injectors for axillary hyperhidrosis. Under training in Ireland and the UK, he first started performing this procedure in 2001. To date he has performed over five thousand cases. He is also a National trainer in this procedure, and on the advisory board.
He founded Sweat Free- a National society for the treatment of hyperhidrosis.
Apart from Botox, Dr Lim was also the first doctor in Australia to undergo miraDry training overseas- well before the launch of this machine in Australia in 2014.
He is also a leading member of the International Hyperhidrosis Society.
What are treatment options based upon areas of sweating?
So far patients should know the following facts on sweating-
Excessive sweating of the underarms– best treatment is Botox, followed by ETS.
Excessive sweating of the hands and feet– iontophoresis is best, glycopyrrolate iontophoresis is better. Botox works well but it is very expensive and needs to be repeated every 3-4 months. Unlike Botox for the underarms, this treatment is not subsidised by Medicare. Sweaty hands can be treated with ETS.
Excessive sweating for the face, scalp– Botox is best, but like sweaty hands and feet, it does need to be repeated every 3-4 months, and is not covered under Medicare.
What other treatments are available?
- Tablets– these can be prescribed by your GP. Ask for Propanthelene Bromide or Oxybutin. These are not specialist tablets and can be obtained at any pharmacist. Ask your GP for a script.
- Surgery its an option for sweaty hands, face, & underarms. A vascular surgeon performs this procedure. Be warned the chances of compensatory sweating (sweating elsewhere) is unpredictable both in location and probability. Up to 50% of patients will suffer from compensatory HH following ETS surgery, most are mild.
- CBT- or cognitive behaviour therapy. This treatment can be useful if you suffer from anxiety related sweating. By combining treatments with a psychologist, this can improve your outcomes. Cognitive Behaviour Therapy is an excellent method for reducing stress.
- Diet– this seems trivial, but if you drink energy drinks or coffee, this will make all forms of sweating worse.
- Topicals include compounded Glycopyrolate solutions ranging from 1 to 3%. A prescription can be obtained from a medical dermatologist.
Davin’s Viewpoint on the management of excessive sweating
Hyperhidrosis is a very common condition and especially debilitating in hot humid cites like Brisbane. Fortunately most patients can be treated effectively. The Medicare and PBS rebate has changed the way we manage underarm sweating. Finally patients do not have to spend a fortune to have excellent sweat reduction. In fact, it works out to about 2 dollars a day to have sweat free underarms.
miraDry is relatively new in Australia, but I am somewhat reserved in regards to this treatment. The ideal candidate must understand that it does not work as well as anti-sweat injections, and it gives you a normal sweat pattern. miraDry permanently reduces sweating by up to 70-80%, however side effects are common. This includes long standing nerve damage, or neuropraxia.
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