hyperhidrosis treatment singapore

    Hyperhidrosis Treatment in Singapore

    Non-surgical permanent reduction of underarm sweat glands.

    Hyperhidrosis treatment options depend on the site of involvement, extent and skin type.

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    • Non-invasive Non-Surgical treatment
    • Reduces Sweating and Odour
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    Hyperhidrosis treatment takes into account the severity of your symptoms and the impact on the quality of your life. Sweating more than necessary may lead to stress, anxiety and depression. The various treatment options range from topical medications, injectables, energy-based devices and surgery.

    What is Hyperhidrosis?

    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.

    What causes Hyperhidrosis?

    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. 

    What are the Secondary causes of Hyperhidrosis?

    • Alcohol
    • Acute or Chronic lung conditions
    • Congestive heart failure
    • Endocrine disorders e.g. Diabetes, Hyperthyroidism, Low blood glucose (Hypoglycaemia)
    • Infectious disease e.g. tuberculosis
    • Certain cancers e.g. carcinoid
    • Menopuase
    • Psychiatric conditions e.g. anxiety disorders
    • Substance abuse

    What medications may cause Hyperhidrosis?

    • Anti-depressants e.g. fluoxetine, venlafaxine
    • Cholinergic agonist e.g. pilocarpine, mestinon
    • Hypoglycaemic agenet e.g. insulin, sulfonylureas
    • Others: Tamoxifen, Infliximab, Sildenafil (Viagra)

    What are the types of Hyperhidrosis?

    1. Palmar Hyperhidrosis:

      • Excessive sweating primarily affecting the palms of the hands.
      • Palmar hyperhidrosis can interfere with activities that require manual dexterity, such as writing, typing, or holding objects.

    2. Plantar Hyperhidrosis:

      • Excessive sweating primarily affecting the soles of the feet.
      • Plantar hyperhidrosis can lead to soggy feet, unpleasant odors, and an increased risk of developing fungal infections (e.g., athlete’s foot).

    3. Axillary Hyperhidrosis (Most Common):

      • Excessive sweating primarily affecting the underarms or armpits.
      • Axillary hyperhidrosis can result in visible sweat stains on clothing, body odor, and discomfort.

    4. Craniofacial Hyperhidrosis:

      • Excessive sweating primarily affecting the face, scalp, and neck.
      • Craniofacial hyperhidrosis can lead to facial sweating, scalp sweating (scalp hyperhidrosis), and excessive sweating around the neck and upper chest.

    5. Generalized Hyperhidrosis:

      • Excessive sweating that occurs throughout the entire body or multiple body areas simultaneously.
      • Generalized hyperhidrosis can be associated with underlying medical conditions, medications, hormonal changes, or emotional triggers.

    6. Focal Hyperhidrosis:

      • Excessive sweating that is localized to specific areas of the body, such as the hands, feet, or underarms.
      • Focal hyperhidrosis can be further classified based on the specific body areas affected, such as palmar hyperhidrosis, plantar hyperhidrosis, or axillary hyperhidrosis.

    How deep are the axillary sweat glands located?

    Sweat gland location within the skin

    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.

    Hyperhidrosis Disease Severity Scale (HDSS)

    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.

    HDSS

    what are the advantages of treating hyperhidrosis?

    • Improves emotional well-being
    • Enhances self-esteem
    • Elevates interpersonal relationships
    • Boost occupational productivity

    hyperhidrosis treatment

    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

    Frequently Asked Questions About Hyperhidrosis

    • This type of hyperhidrosis is idiopathic, meaning its exact cause is unknown.
    • It typically starts during childhood or adolescence and persists throughout adulthood.
    • Primary hyperhidrosis often affects specific areas of the body, such as the palms, soles of the feet, underarms, face, or groin.
    • It can be triggered by emotional factors (emotional sweating) or occur spontaneously (thermal 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:

    1. Precision Targeting: Fractional microneedling RF allows for precise targeting of the sweat glands in the treated area, minimizing damage to surrounding tissues.

    2. 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.

    3. 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.

    4. 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.

    5. 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.

    6. 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.

    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.

    schedule a consultation for hyperhidrosis treatment in singapore

    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.

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    Or give us a call at +65 6769 6007 | WhatsApp us +65 9855 3022

    References:
    1. McConaghy JR, Fosselman D. Hyperhidrosis: management options. American Family Physician. 2018 Jun 1;97(11):729-34.
    2. Nawrocki S, Cha J. The etiology, diagnosis, and management of hyperhidrosis: a comprehensive review: therapeutic options. Journal of the American Academy of Dermatology. 2019 Sep 1;81(3):669-80.
    3. Henning MA, Bouazzi D, Jemec GB. Treatment of hyperhidrosis: an update. American Journal of Clinical Dermatology. 2022 Sep;23(5):635-46.
    4. Kim M, Shin JY, Lee J. Efficacy of Fractional Microneedle Radiofrequency Device in the Treatment of Primary Axillary Hyperhidrosis: A Pilot Study.Dermatology 2013;227:243-249
    5. Farahnaz Fatemi Naeini, Bahareh Abtahi-Naeini, Mohsen Pourazizi et al. Fractionated microneedle radiofrequency for treatment of primary axillary hyperhidrosis: A sham control study. Australasian Journal of Dermatology. 2015;56(4):279-284
    6. Purtuloglu T, Atim A, Deniz S, Kavakli K, Sapmaz E, Gurkok S, et al. Effect of radiofrequency ablation and comparison with surgical sympathectomy in palmar hyperhidrosis. Eur J Cardiothorac Surg. 2013 Feb 21.
    7. Perez Rivera, F. Pilot study for permanent resolution of axillary hyperhidrosis: elimination of sweat glands with intradermal microneedle radiofrequency. Eur J Plast Surg 42, 161–168 (2019). 
    8. Abtahi-Naeini B., Naeini F. F., Adibi N., Pourazizi M. Quality of life in patients with primary axillary hyperhidrosis before and after treatment with fractionated microneedle radiofrequency. Journal of Research in Medical Sciences. 2015;20(7):631–635.