Hyperhidrosis treatment options depend on the site of involvement, extent and skin type.
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Hyperhidrosis is the medical term to describe excessive sweating, a condition that affects about 3% of the population. More than half of affected individuals are never diagnosed as they may be unaware of treatment options available. The exact cause of hyperhidrosis is unknown but is suspected to be due to an overactive nerve input that stimulates the sweat (eccrine) glands, which can be addressed through various hyperhidrosis treatment approaches.
Over 90% of hyperhidrosis cases are primary (cause is unknown), with the remaining 10% are due to secondary causes. With over 50% of cases affecting mostly the axilla, more than one-third of these cases find that it significantly affects their daily activities. There may be a genetic component as two-thirds of patients will have a positive family history.
Palmar Hyperhidrosis:
Plantar Hyperhidrosis:
Axillary Hyperhidrosis (Most Common):
Craniofacial Hyperhidrosis:
Generalized Hyperhidrosis:
Focal Hyperhidrosis:
The eccrine sweat glands cover most part of the body save the ear canals. The coiled stucture of the sweat gland releases perspiration and salt into the external skin to lower the body temperature via evaporation.
Histological analysis of individuals with axillary hyperhidrosis demonstrates that the sweat glands are located, on average, about 3.5mm in depth from the skin surface. Devices such as fractional microneedle radiofrequency treatments can effectively target sweat glands at such depths.
Hyperhidrosis treatments in Singapore that are able to reach this depth with minimal injury to the surrounding skin structures would be preferable.
How is excessive sweating affecting your life? The hyperhidrosis disease severity scale is a validated tool to select patients for therapy and to assess their response to hyperhidrosis treatment in Singapore.
A score of 1 to 2 is rated as mild to moderate, while a score of 3 or 4 is considered severe. After hyperhidrosis treatment, a 1-point and 2-point improvement correlates with a 50% and 80% reduction in sweat production respectively.
Topical aluminum salts are often the first line treatment for hyperhidrosis. They act on the sweat glands by reducing the action of secretory cells and thereby localized sweating. The most common aluminum salt is 20% aluminum chloride.
Glycopyrronium bromide is a topical medication that blocks the action of acetylcholine (a neurotransmitter) and, thereby, inhibits local sweating.
Oral medications such as oxybutynin block receptors that inhibit the action of acetylcholine. However, it is associated with side effects such as dry mouth, nausea, diarrhea, gastroesophageal refux, headache, dizziness, fushing, blurred vision, urinary retention, tiredness, and constipation.
In iontophoresis, the skin is exposed to a weak electric current that causes ions to pass across the skin surface, which is believed to alter the local pH, block the sweat ducts, or inhibit the sympathetic nervous system that innervates the sweat glands. Iontophoresis may be effective treatment for primary hyperhidrosis of the palms or soles.
BTX is injected into the skin where it blocks the release of acetylcholine from the nerve endings that innervate the sweat glands. It is useful for axillary, palmar and craniofacial hyperhidrosis, with repeated (and costly) injections every 6 months.
Fractional microneedle radiofrequency devices uses a microneedle that allows for precise delivery of energy in the tissue, which can target and destroy your sweat glands. During this procedure, microneedles are placed 2 to 3.5 mm under the skin, and radiofrequency energy is applied. This therapy results in a decrease in the HDSS score of at least one point in nearly 80% of patients. They have the advantage of minimal skin trauma, ability to reach depths up to 3.5mm and are considered safer compared to laser devices for darker skin type. Examples of these devices include:
A microwave device delivers heat to the tissue that inducesthermolysis (heat induced destruction) of the sweat glands, which inhibits local sweating.
Surgery is considered when conservative treatments have failed.
Local surgical techniques include excision, curettage, liposuction, or a combination of these techniques.
Sympathectomy is the treatment of last resort in the management of hyperhidrosis. The most common long-term complication after sympathectomy is compensatory sweating.
Antiperspirants containing aluminum chloride are often effective for mild to moderate cases of hyperhidrosis by blocking sweat ducts.
Fractional microneedling with radiofrequency (RF) is a minimally invasive procedure that has shown promise in the treatment of hyperhidrosis, particularly axillary hyperhidrosis (excessive sweating in the underarms). Some advantages of fractional microneedling RF for hyperhidrosis include:
Minimal Side Effects: Fractional microneedling RF is associated with minimal side effects compared to more invasive procedures. Patients may experience temporary redness, swelling, or mild discomfort at the treatment site, but these typically resolve within a few days.
Precision Targeting: Fractional microneedling RF allows for precise targeting of the sweat glands in the treated area, minimizing damage to surrounding tissues.
Minimally Invasive: Compared to surgical interventions such as sympathectomy (surgical interruption of sympathetic nerve signals) or sweat gland removal, fractional microneedling RF is minimally invasive and does not require extensive downtime.
Stimulates Collagen Production: The microneedles used in the procedure create controlled micro-injuries in the skin, which stimulate the body’s natural healing response and promote collagen production. This can lead to improved skin texture and tone in addition to reducing sweating.
Long-lasting Results: Fractional microneedling RF has been reported to provide long-lasting results for hyperhidrosis, with many patients experiencing a reduction in sweating for several months to a year or more after treatment.
Customizable Treatment: The depth of needle penetration and the intensity of RF energy can be adjusted based on the individual patient’s needs, allowing for a customized treatment approach.
Daily management strategies for hyperhidrosis include wearing moisture-wicking clothing, using absorbent materials or pads in affected areas, practicing good hygiene, avoiding triggers such as spicy foods or caffeine, and managing stress through relaxation techniques or therapy.
Botulinum toxin injections (Botox) can provide significant relief from excessive sweating for several months, typically around 4 to 6 months. Repeat injections may be necessary to maintain the effects.
Side effects may vary depending on the treatment but can include skin irritation, dry mouth, blurred vision (with anticholinergics), and compensatory sweating in untreated areas (with sympathectomy).
In severe cases that don’t respond to other treatments, surgical options like sympathectomy (nerve surgery) or surgical removal of sweat glands may be considered, but they carry risks and are usually considered a last resort.
Hyperhidrosis can have profound impact on an individual's way of life. Treatment depends on the site of involvement, skin type and aims of treatment. Contact us today to schedule a consultation, so that Dr. Ng can develop a personalized treatment approach for resolving your skin concerns and helping you to achieve long-term improvements in the health and appearance of your skin.
Our approach to hyperhidrosis treatment is multifaceted, combining the latest advancements in medical science with a patient-centered care philosophy. Initial evaluations include a thorough medical history and assessment to identify underlying causes and the extent of the condition. Treatment options are then tailored to each patient’s specific needs, ensuring optimal outcomes.
Dr. Moses Ng is a distinguished professional in the field of aesthetic medicine, renowned for his expertise in advanced cosmetic procedures. With over 15 years of experience, extensive training and a keen eye for detail, Dr. Ng specializes in a wide range of treatments, including injectables, laser therapies, and acne scar management.
Dr. Moses Ng’s commitment to excellence and patient-centric approach have earned him a reputation as a trusted clinician in aesthetic medicine. His continuous pursuit of the latest advancements in the field ensures that his patients receive the highest standard of care and the most effective treatments available.