Hyperhidrosis is the medical term for excessive sweating. There are two types of hyperhidrosis, Primary or Idiopathic and the second, Secondary Hyperhidrosis. Of the two, primary hyperhidrosis is not very amenable to treatment as it has no underlying cause. In Secondary hyperhidrosis, the diagnosis and treatment of the underlying disease condition stops the excessive sweating. Primary hyperhidrosis is generally managed by physical barriers to prevent the sweat from coming out. It is only in extremely severe cases that interventions like Iontophoresis, Botox injections, Microwave and Laser therapy and finally surgical severance of the sympathetic nerve and removal of sweat glands are resorted to.

Sweat by itself is odorless. However, it is when the bacteria use it as food and multiply that sweat starts smelling. It is the product of the bacterial breakdown of Keratin, a protein that is present on the skin surface.

Management of Sweat
– Two physical approaches are usually employed. One is the use of antiperspirants which normally block the sweat gland ducts. The second is to mask the odor of sweat with some other strong scents. Some of the modern antiperspirant-deodorant combinations have some mild antibacterial agents added to it.

– Body odor is normally associated with armpits. The fact is any area which allows sweat to accumulate like groin, around the anal area, upper thighs and feet can all be smelly.

– In very severe cases advanced methods like Iontophoresis, Botox injections, Microwave and Laser therapy can be tried. The selected area is heated by using microwaves and the Skin is cooled during the treatment which generally takes an hour. It is carried out under local anesthesia. It is repeated 2 to 3 times if required.

– In the very severe cases, one can resort to surgical methods. The surgical procedure involves the severance of the sympathetic nerve near the armpit. In the other the offending sweat glands are surgically incised and removed. Iontophoresis involves passing a weak direct current through the skin using tap water. This treatment is painless. The procedure is done for about 10 to 20 minutes and repeated once in one or two weeks.

– The FDA has cleared Botox treatment only for underarm hyperhidrosis. It consists of giving injections Botox in 20 to 25 selected spots with a fine needle. It gives relief for 12 to 14 months. The injections are very painful and using a fine needle makes it tolerable.