Too much sweating? MiraDry could be your cure.

Excessive sweating beyond that which is required to regulate body temperature is medically termed hyperhidrosis. It is estimated to affect over 3% of the US population, which is quite common as far as medical conditions go. And according to quality of life studies, few medical conditions that are this common have as significant an emotional and social burden as hyperhidrosis. The most commonly affected body sites include palms, soles, armpits, face and scalp. These are also areas that are naturally high in sweat gland density.

Hyperhidrosis can be primary or idiopathic, which means it occurs without any apparent cause. Or it can be secondary, meaning that it is the result or side effect of something else like medications, hormonal changes, or other illnesses. It can also be localized to one area of the body, just on the hands for example, or it can be generalized with increased sweating from many areas of the body together. When hyperhidrosis is secondary it is usually generalized, affecting many areas of the body.

How do you know if you have primary hyperhidrosis? Check out the diagnostic criteria:

  1. You have Excessive sweating of 6 months or more located in axillae, palms, soles or craniofacial region
  2. There is no apparent secondary cause, such as medications, endocrine, or neurologic disease.
  3. You also have two or more of the following characteristics:
  • Symmetric, affecting both sides of the body.
  • Not present during the night
  • Episodes occur at least weekly
  • Onset of the problem before the age of 26
  • There is a family history of excessive sweating
  • The sweating is so much that it impairs normal daily activities

How do we treat it?

There are various treatments including topical solutions, systemic medications, and a variety of procedures. I’ll review a few of them very briefly.

Topical treatments are the first thing to try. There are several possible topical options, but the most common are prescription strength medications with up to a 20% Aluminum Chloride solution. These are often cheap and quite effective, but occasionally irritating to the skin.

Iontophoresis is another option, most often used for hyperhidrosis affecting just the palms or the soles.  It is a technique that involves immersion of the palms or soles in small, electrode-containing plastic trays with tap water. A very mild electric current is applied. This, we think, helps force sodium and other ions from the water into the sweat gland openings, forming plugs that restrict release of sweat from the ducts. Side-effects including minor discomfort during treatment and skin irritation such as burning, tingling and erythema rarely occur. The amount of time required for therapy is sometimes bothersome to patients, as each session is given over 20 min and it is necessary to treat at least a few times a week in order to maintain improvement.

Botox, Botulinum toxin, is a great way to treat focal areas of hyperhidrosis. It is a neuromodulator that works to stop nerves from firing by blocking presynaptic acetylcholine release. Since the nerves that activate the sweat glands are controlled by acetylcholine release, Botox does a nice job at decreasing sweat gland production. Botox injections are less invasive than surgical procedures and provide longer-lasting results than topical therapies. The effects last for 4–9 months on average and are associated with a very high satisfaction rate among patients.

This brings me to microwave energy, the motivation for the post. It is an exciting new therapy for excessive underarm sweating. The technology is called MiraDry, and there is nothing else out there like it. MiraDry uses microwave technology to permanently destroy the sweat glands in the armpits, and it is getting a lot of press these days in the cosmetic medical literature. It is approximately a one-hour procedure done in the clinic under local anesthesia to both armpits. Up to 80% of the sweat glands are destroyed after just one treatment, but two treatments appear to be required to achieve optimal results. Biopsies performed on skin treated up to one year previous have shown marked decrease in sweat glands, and since sweat glands are thought to not regenerate, this seems to support the company’s claims of long-term results. Side effects include transient swelling, discomfort and numbness, as well as redness, bruising, and partial underarm hair loss. Of course, evolving data regarding safety, therapeutic settings, efficacy, side effects and long-term follow-up will continue, as this treatment option is relatively new.

But the patients that I’ve treated are extremely pleased with this approach and I love being able to offer a treatment with such positive and potentially permanent results.

  

5 thoughts on “Too much sweating? MiraDry could be your cure.

    1. I think that Botox and Microwave therapy are clearly the most effective and safest ways to treat underarm sweating that is not well controlled with prescription strength topical medicine. While I have seen a portion of the botox for hyperhidrosis get covered by insurances in rare circumstances, the short answer is no. Neither Botox nor Miradry is covered by insurance. Cost can vary markedly depending on the practice and geographic location. Botox, in many practices is charged by the unit, and an effective treatment will take 50 to 100 units each armpit. This usually ends up costing $500 to $1000 or more per treatment, and most patients need at least 2 treatments a year. MiraDry costs anywhere from $2500-4500 but the results should be long lasting.

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    2. I’ve looked a little bit further into this and it appears that the cost of botox for hyperhidrosis is partially covered more often then I initially implied. While it has been my experience that insurance companies do often reject the claim, it is occasionally covered here in New York according to my colleagues.

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  1. Teri Faulkner

    Dearest David, mommy says hi here from Park City!We’ve been discussing botulinum toxin this afternoon and have a few questions. First does the paralyzed muscle can atrophy and then lose its ability to function and droop upon suspension of treatment? Once you start are on it for life? What are future risks as far as possible side effects, cancer, lumpy hardened skin and or muscle?

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    1. Hi Teri,

      Yes I have seen muscle atrophy in some patients that have been using botox for many years. I have also seen some patients that have been using botox for years that don’t have noticeable atrophy. Thanks to the temporary effects of botox, if noticeable atrophy does occur, you can decrease the frequency of the treatments, or the amount used. Atrophy, however, does not result in drooping of the muscles.

      Yes the results of botox are temporary. This means that if you like the results you get from botox, you would need to continue treatments on occasion. But this does not necessarily mean that you are on it for life.

      Cosmetic Botox is not typically associated with significant longterm adverse events. It is not associated with cancer, or lumpy hardened skin or muscle.

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