Texas Cosmetic Dermatology Blog

Hyperhidrosis (excessive sweating) most commonly affects the palms, soles of feet, underarms and face causing embarrassment and interference with daily activities. It is estimated that almost 3 percent of Americans have excessive sweating.

There are two types of hyperhidrosis:

Primary hyperhidrosis

• Excess sweating results from emotional stimuli without underlying medical disorder.
• Palmar/plantar hyperhidrosis affects the hands/feet. Sweaty palms is the most troublesome symptom.
• Palmar/axillary hyperhidrosis affects palms/armpits.
• Axillary hyperhidrosis affects only the armpits.
• Craniofacial hyperhidrosis affects the face and head. It's the least common form.

Secondary hyperhidrosis

Secondary hyperhidrosis is the result of an underlying medical condition such as neurologic or endocrine disorders, spinal cord injury etc. Treatment is aimed at correcting the underlying medical condition.

Depending on the severity there are several treatment options for hyperhidrosis:

Topical medications

For mild hyperhidrosis, nonprescription, over-the-counter, antiperspirant applied topically is a good initial treatment.Some options to consider are Secret Clinical Strength, Degree Clinical Protections and 5 Day.

For moderate hyperhidrosis prescription antiperspirants (Drysol, Xerac) are the next choice. These antiperspirants are applied at bedtime, left on for 6 to 8 hours and must be washed off in the morning. Dryness, itching and redness are some of the common side effects.

Oral Medications

Several oral medications can help control hyperhidrosis.

• Anticholinergics (such as glycopyrrolate) block nerve impulses to sweat glands.
• Carbonic anhydrase inhibitors (such as topiramate) inhibit sweating.
• Clonidine reduces nerve stimuli, thereby reducing sweat output.

I do not prescribe oral antiperspirant medication due to their side effects.

Older types of antidepressants, such as amitriptyline, can reduce sweating and also can help patients cope with hyperhidrosis. Possible side effects are dry mouth, blurred vision and difficulty with urination. Anti-anxiety medications are an option for patients whose excessive sweating is primarily due to stress-induced anxiety. But they usually aren't effective.

Botulinum Toxin (Botox)

Botulinum toxin (Botox) injections reduce sweating by blocking the nerves that trigger sweat glands. The U.S. FDA approved Botox for axillary (underarm) hyperhidrosis in 2004.

I have treated several hyperhidrosis patients with Botox with excellent results!

Use of diagnostic sweat tests to determine injection sites improves results with lower doses of Botox. The procedure is very well tolerated and takes 10-15 minutes to perform for each area. Patients report significant reduction in sweating within 3-5 days and the effects last from 4-6 months depending on individual patients

Botox is used most successfully for underarm hyperhidrosis but it can be used for palms and soles. I perform this procedure less frequently for facial sweating due to risk of facial muscle weakness, which although transient, is cosmetically undesirable

Surgery

For severe hyperhidrosis and failure to respond to other types of treatments, surgery is an option. You need to find an experienced surgeon for this type of treatment. Surgery involves interrupting the nerve signal triggering excessive sweating. We do not offer surgical treatment for hyperhidrosis.

For more information on non surgical hyperhidrosis treatments including Botox for hyperhidrosis please visit our website or call our office at 888-210-9693 for an appointment.

LEGAL DISCLAIMER

The information on this Web site is provided by Naila Malik MD for educational purposes only. It is not a substitute for professional medical care, and medical advice and services are not being offered. If you have, or suspect you have, a health problem you should consult your physician. Only your doctor can provide you with advice on what is safe and effective for you. Never disregard professional medical advice or delay in seeking it because of something you have read on the Site!
THE SITE DOES NOT PROVIDE MEDICAL ADVICE.

Cystic or nodulo-cystic acne is a severe type of acne marked by painful, red, irritated breakouts on the face and body often leading to pitted scars if left untreated.

The pimples and pustules of cystic acne are raised, red and filled with pus. Sometimes the lesions extend deep and merge together to form nodules, hard painful lumps underneath the skin. Nodules are difficult to treat with conventional medical treatments, very slow to heal and frequently lead to deep scarring.

The causes of cystic acne are not completely understood but genetic predisposition seems to play a part in predicting incidence.

A few factors make cystic acne worse in genetically predisposed individuals. These include hormonal changes or imbalances, certain dietary ingredients, humidity, sweating etc. Cystic acne is more common in teenagers, boys more than girls .

A multi desiplinary approach to treating cystic acne works best for long term management of lesions and prevention of scarring.

I combine Lifestyle modification (dietary consideration, vitamin supplements, stress management, adequate skin care) with 6 to 10 weeks of prescription oral antibiotics to control inflammation. I also incorporate office treatments like regular cyst extractions, Medical microdermabrasion and Medicated Chemical peels to improve surface texture and reduce cyst formation.

In our practice, for patients who do not respond adequately to the above measures, 2 to 4 sessions of Photodynamic Therapy (PDT) performed four weeks apart provide satisfactory results. Most of our cystic acne patients who underwent Photodynamic Therapy had over 90% reduction of cysts, nodules and inflammation. Combining this type of treatment with microdermabrasion leads to improvement in skin texture and reduction of scars.

For Photodynamic Therapy we combine ALA (Amino Levulinic acid ) application with Intense Pulse Light. There is relatively little downtime following this treatment, some patients may experience mild to moderate redness, flaking and peeling of the treated area for 2-5 days following the treatment. This treatment is very well tolerated provided the patients follow the post treatment instructions carefully. It is essential to avoid sunlight exposure for at least 48 hours after the treatment.

Some women are given medications like Spironolactone or oral contraceptives to regulate hormonal imbalance. I personally do not prescribe oral contraceptives or Spironolactone for acne due to the undesirable side effects from these medications.

Accutane has been used for many years to successfully treat cystic acne. I do not prescribe Accutane due to the large number of potentially dangerous side effects from Accutane. Studies indicate comparable treatment success rate from accutane and PDT. Cost of PDT is comparable to Accutane as well with none of the side effects so commonly reported with Accutane.

For pitted acne scars, CO2 fractional laser resurfacing works very well in reducing surface irregularity and filling in the deep defects. For severe scarring, most people need more than one session of resurfacing.

Mild acne scarring can be improved with a series of medical microdermabrasion and chemical peels.

For further information on Photodynamic Therapy for cystic acne visit our website or call our office at 888-210-9693 for an appointment.

LEGAL DISCLAIMER

The information on this Web site is provided by Naila Malik MD for educational purposes only. It is not a substitute for professional medical care, and medical advice and services are not being offered. If you have, or suspect you have, a health problem you should consult your physician. Only your doctor can provide you with advice on what is safe and effective for you. Never disregard professional medical advice or delay in seeking it because of something you have read on the Site!
THE SITE DOES NOT PROVIDE MEDICAL ADVICE.