- Dr. Kuzel
- Treatments
- Conditions
- Calgary South
- Articles
- (403) 286-6888
- Contact Us
Book a consultation
Hyperhidrosis is sweating beyond what the body needs to regulate temperature. It affects about three percent of the population, most often the underarms, palms, soles and face, and it is treatable. At Rejuvenation Dermatology Calgary South, Dr. Paul Kuzel, a board-certified dermatologist, distinguishes primary from secondary hyperhidrosis and treats it with topical therapy, botulinum toxin, oral medication and device-based options.
Sweating is controlled by the sympathetic nervous system. In hyperhidrosis the glands are normal in number and structure, but the nerve signal to them is exaggerated, so they produce sweat in the absence of heat or exertion.
Most hyperhidrosis is primary and needs no investigation beyond a history and examination. A minority is secondary to a medical condition or a medication, and the pattern usually gives it away.
Excessive sweating at one or more specific sites, symmetrical, present for six months or more, beginning before age twenty-five, absent during sleep, and often with a family history.
Sweating that is generalised rather than focal, begins in adulthood, occurs during sleep, or is accompanied by weight loss, fever or other symptoms. Causes include thyroid disease, diabetes, menopause, infection, certain medications and, rarely, malignancy.
Antidepressants, some diabetes medications, opioids and hormonal treatments can cause or worsen sweating. A medication review is part of every assessment, and a change is sometimes all that is needed.
Severity is graded on a four-point scale according to how much the sweating interferes with daily activities. Grades three and four indicate treatment beyond topical therapy is likely to be needed, and are the threshold at which botulinum toxin is considered.
Hyperhidrosis is under-diagnosed and under-treated. Most patients have never been told it has a name, or that treatments beyond antiperspirant exist.
Each site has a first-line treatment and a next step. Most patients with hyperhidrosis at more than one site are treated at each according to its own ladder.
Assessment of hyperhidrosis is medical care, generally covered by Alberta Health Care with a referral from your family physician. Ask your doctor to refer you to Dr. Paul Kuzel at Rejuvenation Dermatology Calgary South, or have the referral faxed to (403) 225-2914.
Botulinum toxin for severe underarm sweating is a medical indication, and the product is covered by many private plans with prior authorisation. Call (403) 286-6888 and the team will advise on coverage and fees for your plan.
Treatment begins with the least invasive option effective for the site, and steps up according to response and severity.
Aluminium chloride at prescription strength, applied to dry skin at night, blocks the sweat duct and is effective for mild to moderate underarm, hand and foot sweating. Topical anticholinergic wipes (glycopyrronium) reduce underarm sweating with once-daily use and are approved from age nine.
A grid of small intradermal injections across the sweating area blocks the nerve signal to the glands. For the underarms, sweating stops within a week and the effect lasts four to twelve months, typically six to nine. Also used for palms, soles, forehead and scalp, with a nerve block or topical anaesthetic for the hands and feet.
Glycopyrrolate or oxybutynin, taken daily, reduces sweating across the whole body. Useful for facial and scalp sweating, for generalised hyperhidrosis, and as an adjunct to site-directed treatment. Dose is titrated to balance benefit against dry mouth, the principal side effect.
The hands or feet are placed in shallow trays of tap water through which a low electrical current is passed for twenty to thirty minutes. Repeated several times a week initially, then weekly for maintenance. Home devices are available and effective for most patients with palmar or plantar hyperhidrosis.
A device-based treatment that destroys underarm sweat glands with microwave energy, producing a lasting reduction in sweating after one or two sessions. Referral is arranged where this is appropriate and the patient prefers a permanent option to repeated injections.
Endoscopic thoracic sympathectomy interrupts the nerve supply to the palms and is reserved for severe palmar hyperhidrosis that has failed all other treatment, because of the risk of compensatory sweating elsewhere. Referral to thoracic surgery is arranged in selected cases.
The first visit establishes whether the hyperhidrosis is primary or secondary, grades its severity, and sets the treatment for each affected site. Botulinum toxin can often be scheduled at the same visit.
Prescription topical treatment reduces sweating within one to two weeks in most patients with mild to moderate hyperhidrosis, and is continued for as long as it is needed. Botulinum toxin reduces underarm sweating by more than eighty percent in the large majority of patients, with onset within a week and a duration of four to twelve months, after which it is repeated.
Palms and soles respond to iontophoresis in most patients within two to three weeks of regular use, and to botulinum toxin where iontophoresis is insufficient. Oral medication reduces generalised and facial sweating within days, with the dose adjusted to limit dry mouth.
Primary hyperhidrosis is a lifelong tendency and treatment is maintained rather than completed. Many patients find that sweating lessens with age. Secondary hyperhidrosis resolves when the cause is treated.
Sweating that occurs without heat or exertion, at specific sites, that interferes with daily activities, work or social life, and that has been present for six months or more is hyperhidrosis. If you change shirts during the day, avoid handshakes, or plan your clothing around sweating, it is worth assessing.
Assessment is medical dermatology and is generally covered with a referral. Prescriptions are covered by most drug plans. Botulinum toxin for severe underarm hyperhidrosis is a recognised medical indication and the product is covered by many private plans with prior authorisation; the injection fee is quoted at consultation. Treatment of other sites is quoted individually.
For a covered assessment, a referral from a physician is the normal route, and it can be faxed to (403) 225-2914. If you do not have a family doctor or would rather not wait, call (403) 286-6888 and the team will advise.
Botulinum toxin blocks the release of acetylcholine, the chemical the nerves use to switch on sweat glands. Injected in a grid across the sweating area, it silences the glands in that area for several months. It does not affect sweating elsewhere and does not affect the body's ability to regulate temperature.
Underarm injections are brief and well tolerated; most patients describe a series of small pinches over a few minutes. The palms and soles are more sensitive and are numbed with a nerve block, topical anaesthetic or cold before injection.
Four to twelve months, typically six to nine, for the underarms. The palms and soles tend toward the shorter end. Treatment is repeated when sweating returns, and many patients find the interval lengthens over successive treatments.
Primary focal hyperhidrosis is diagnosed on history and examination and needs no tests. Where the pattern suggests a secondary cause, blood tests for thyroid function, blood sugar and other markers are ordered. A starch-iodine test is used in clinic to map the sweating area before injection.
The anticholinergic medications used for hyperhidrosis cause dry mouth in most patients, and can cause dry eyes, constipation or blurred vision at higher doses. The dose is started low and increased until sweating is controlled with acceptable side effects. They are avoided in patients with glaucoma or urinary retention.
Yes. Hyperhidrosis commonly begins in adolescence, and topical treatments, including anticholinergic wipes, are approved for children. Iontophoresis is suitable for older children. Botulinum toxin is used in adolescents with severe underarm sweating on a case-by-case basis.
Dr. Paul Kuzel, MD FRCPC, a board-certified dermatologist and the founder and Medical Director of Rejuvenation Dermatology Calgary South. He sees patients in English and Czech.
Grouped by what you are trying to find out.
Book a consultation with Dr. Kuzel, or ask your family physician for a referral.
Rejuvenation Dermatology Calgary South
10201 Southport Rd SW #102
Calgary, AB T2W 4X9
Two blocks west of the Delta Hotel
(403) 286-6888
Referrals by fax: (403) 225-2914
Open seven days a week, with early mornings and evenings on weekdays.
Take the first step toward achieving healthy, radiant, and flawless skin. Contact Rejuvenation Medical Aesthetics today to schedule your personalized consultation and explore the advanced treatments tailored to your unique needs.
