Excessive sweating

Hyperhidrosis refers to sweating that exceeds the body’s needs for thermal regulation; it calls for medical management when it has an impact on daily, working or social life, and my approach seeks first to understand that impact before contemplating any procedure at all. Two avenues may be considered, depending on the case. Injections of botulinum toxin aim to reduce the stimulation of the sweat glands in the treated area; microwave treatment, for its part, uses energy delivered through the skin and targets the sweat glands of the axillary region. The choice between these techniques, when it is possible, is discussed and settled in consultation, with nothing automatic and without preconception.

Course of the session

Preceded by an examination of the area concerned and by its delimitation, the session proceeds, according to the technique selected, either through a series of injection points distributed over the area, or through the application of the device to the skin. Measures intended to improve comfort may be offered, and are set out beforehand. The number of sessions, their spacing and the length of each depend on the technique, on the area and on each person’s own situation: I specify them in consultation, without fixing them in advance.

Areas and situations

The underarms and the hands are among the sites most often concerned, it being understood that not all techniques apply to all areas. Management is generally considered when the usual local measures have not brought sufficient improvement. Excessive sweating may also stem from a general cause or from a current treatment; an assessment is sometimes necessary before a procedure is contemplated, since situations of similar appearance may arise from different mechanisms. Depending on the case, the procedure may not be indicated.

Possible after-effects

Certain after-effects may occur: redness, swelling, tenderness or bruising at the treated area. After injections, a transient muscular weakness of the neighbouring muscles may be observed, in particular in the hands; after microwave treatment, oedema, induration or a transient change in sensation may appear. Other, rarer effects exist. The effect is not permanent and its intensity varies from one person to another; my concern is therefore to inform with measure, without announcing any result in advance.

A prior consultation is mandatory. It allows the area to be examined, a possible cause requiring treatment to be looked for, contraindications to be assessed, the techniques that may be considered, their limits and their risks to be set out, and written information to be provided before any decision.