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BOTOX® and Hyperhidrosis

Around seven million Americans suffer from hyperhidrosis, or excessive sweating, producing up to five times the amount of sweat needed to regulate body temperature. Their damp hands and sweaty armpits can become a cause for social awkwardness and self-conscious behavior. Recently, a number of new treatments for hyperhidrosis have appeared, including the use of BOTOX® injections. The BOTOX® treatment for hyperhidrosis is expected to win FDA approval this year, although it has already been used for this purpose by physicians in the United States. The main type of hyperhidrosis is primary or idiopathic hyperhidrosis-which usually begins in childhood or adolescence. The sweat glands are normal, but the central nervous system responds in an exaggerated manner to triggers such as emotional stress or hot weather, causing the individual to sweat profusely. The precise cause is unknown, and the disorder is usually limited to certain areas of the body such as the palms of the hands, soles of the feet and the armpits. Sufferers usually have a family history of excessive sweating. Past treatments have included antiperspirants, including prescription strength formulas, and iontophoresis, a procedure that applies an electrical current to the skin through tap water, effectively blocking the sweat glands. Both of these treatments have drawbacks: antiperspirants can irritate the skin, and iontophoresis can take up to a half an hour for each area. Two newer treatments provide an alternative. Endoscopic transthoracic sympathectomy is a surgical procedure that interrupts the nerves in the chest that control sweat glands in the armpits, palms and soles. During surgery, a video camera and surgical instruments are inserted in the chest through small incisions. The surgeon then clamps, cuts, or cauterizes the nerves. There is a high risk in this procedure for a side effect that will result in compensatory sweating in the back, torso, and inner thighs. Compensatory sweating may occur in as many as 85 percent of patients, although the vast majority of them describe the compensatory sweating as mild. BOTOX® injections provide a less drastic alternative for the treatment of hyperhidrosis. Many doctors are already using it, and FDA approval is expected to come some time this year. The procedure is simple and takes less than 15 minutes in most cases. The BOTOX® is injected into the axilla with a small needle, and can be administered under the arms, or on the palms and soles. Injections last four to nine months, depending upon the individual and the location of treatment. The side effects include pain, which can be treated with topical anesthetics beforehand and muscle weakness, which usually subsides on its own. The major drawback is the cost: injecting both armpits can cost several thousand dollars a year, and most patients must pay out of pocket. Nevertheless, BOTOX® allows these patients an unprecedented sense of freedom.
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