How to Prevent Excess Sweating Like Sweaty Armpits- Treatment Options for Hyperhidrosis

How to Prevent Excess Sweating Like Sweaty Armpits- Treatment Options for Hyperhidrosis

by Natan Schleider, M.D.

June 23rd, 2018

Vintage Advertisement for Treating Sweaty Smelly Armpits (Circa Early 20th Century)

With temperatures on the rise here in New York City now that summer is here (and special thanks to climate change), I find myself sweating profusely. While this may be normal, when shirts, armpits, and back are sticking to your shirt, I feel quite uncomfortable. This may be due to dehydration but frankly, seeing patients with sweat dripping down my brow and back, I feel unprofessional to say the least.

While excess sweating is known to cause ‘social, emotional, and work impairment’ (American Family Physician Vol 97 Number 11 June 1st 2018), up to 3% of the United States population may suffer from hyperhidrosis (the fancy medical word for sweating beyond which is normal).

To stay cool and dry when your antiperspirant deodorant isn’t cutting it, here are  management and treatment options from a medical doctor’s perspective. (I will leave natural remedies to any naturopathic doctors but would love to hear if you have any natural or herbal remedies that work (other than a recycled paper towel):

  1. First line treatment for sweaty underarms is aluminum chloride (Drysol) 20% applied to affected skin nightly or every other night depending on how much you sweat. Note this may cause skin irritation and I would not use this on the face. For the face (craniofacial hyperhidrosis) your pharmacist can compound (mix) topical 2% glycopyrrolate cream applied every one to three days.
  2. Iontophoresis (passing of water through the skin by electrical current–sounds like quackery to me but data supports this apparently) for hyperhidrosis of palms of hands and soles of feet.
  3. Botulinum Toxin like onabotulinotoixnA (aka Botox) can be first or second line treatment and can be injected into the skin of axillae (armpits, palms, and soles and lasts 6-9 months. I have had trouble getting this covered by insurance but the stuff works.
  4. If you don’t like the idea of smearing cream on regularly ot getting injections, two oral prescription medicines are available: oxybutinin 2.5 mg to 10 mg daily and glycopyrrolate.
  5. Noninvasive microwave zapping of sweat glands in the armpits is relatively new with at least 2 treatments needed to reduce sweating by about 50%.
  6. Fractionated microneedle ablation (another way to zap and kill sweat glans) using local anesthesia can work well with at least 1-3 treatments required in general.
  7. If all else fails for hyperhidrosis, we turn to surgery which can be done: liposuction curretage; endoscopic thoracic sympathectomy (very small incisions in skin of chest) cutting the nerves to the problematic sweaty areas.

If you don’t like the above, stay inside, relax if a cool air-conditioned room if available, and take your Vitamin D as you won’t be getting sun exposure indoors (although some UV sunlight does come through windows but that’s a different topic.

Any questions, comments, idea, critiques, I’d love to hear them on http://www.twitter.com or http://www.facebook.com.

 

 

Top 20 Medical Studies of 2017 Reveal that LESS IS MORE

Top 20 Medical Studies of 2017 Reveal that LESS IS MORE

By Natan Schleider, M.D.

June 3rd, 2018

The Doctor, by Jan van Staveren after Gerrit Dou, 1650-69, Dutch painting, oil on copper. Doctor holding a bottle against light to examine a patient’s urine.

As long as I’ve wanted to be a doctor (some 30 years now) it was a veritable fact that Type II diabetics not on insulin should routinely check their blood sugar at home.

Wrong! Or so says the recent American Family Physician of May 1st, 2018 Vol 97, No.9 P.584. A 1 year study showed patients were less happy checking blood sugars at home nor did they have any improved HbA1c levels (a long term marker of blood sugar). They did not get more low blood sugar. And doctors ‘did not seem to respond’ to the home blood sugar tests patients brought in. Get rid of the test strips and painful fingersticks and if you (or your doctor) tell want to monitor home blood sugars, might as well just taste your urine (or rather have your doctor taste it. Seriously. When blood sugar rises above 180-200, the urine tastes sweet and you may be getting into trouble. See how much modern medicine has learned! I bet the diabetes testing companies are bummed out.

Medicine notoriously changes its mind every 10 years or so but some of these studies are real shockers and made me laugh:

  • Sterile gloves do not lower risk of infection for minor procedures like suturing skin lacerations or removing small lumps and bumps. Hand washing and irrigating the wound with regular tap water work just as well.
  • Cortisone injections for arthritis of the knee are not beneficial and may be harmful-don’t do them-plus they hurt like hell in the wrong hands.
  • When discussing cancer screening with older patients, doctors should use the right lingo. Don’t say since you’re probably gonna die soon, you don’t need this screening cancer test, skip the mammogram and go take you grandkids for ice cream. Better to say ‘This test will not help you live longer.’

Something I have been advocating for years is using a statin like Lipitor for primary prevention of heart attacks, strokes, and artery clogging. So if you are 40 or over and have any significant risk factor like smoking, diabetes, high blood pressure, etc, take a statin. I take atorvastatin 80 mg daily and have hypertension and my LDL (bad) cholesterol is great in the 70s!

Conversely, another study found that if you are 65 or older and have no cardiovascular disease, a statin will not be helpful and after age 75, may be harmful. Bottom line: take a stating from age 40-65 to keep arteries clear and then you can stop them if you have not had a heart attack, stroke, peripheral vascular disease, etc.

The American College of Physicians discerned that taking any medicine for back pain is more harmful than helpful. Good for them. When my low back hurts I am still going for Tylenol or Advil–call me weak, I have a low pain threshold.

These are some highlights from the academic world of medicine in 2017. In 10 years medicine will likely change it’s mind when these studies are repeated. but for now as a basic rule in medicine as my mentor told me: ‘Patients get better 95% of the time despite what the doctor recommends.’

If you have any questions or comments, please let me know on Twitter (@DrSchleider) or find me on facebook.

 

Thanks for reading!

Dr. Natan Schleider, M.D.