What are the treatment options in Singapore for excessive sweating?

Q. I am a 38-year-old man who suffers from excessive sweating.

My problem areas include the palms, feet, upper torso and, in particular, the scalp area.

After just a few minutes of moderate activity or simply sitting down on a warm day, I will start to perspire.

A short five-minute walk from my home to the MRT station, for example, can lead to my face and body being covered with perspiration. If I am carrying some moderately heavy things, such as groceries, a short walk can result in sweat dripping off my face.

As my hair is thinning, the sweat beads which form on my scalp are very obvious and, in no time, these beads turn into streams of sweat. This is causing me much embarrassment, especially when I am with my friends or colleagues.

During a fire drill, in which I had to walk down the stairs from the 10th floor, my body and head were covered with perspiration.

Are there any non-surgical treatments for the excessive sweating of the scalp area? How effective are they?

I have read about surgical treatments for hyperhidrosis. How can I find out if they are suitable for me?

Can you explain more about the procedures and their risks? What is the estimated cost of such treatments or surgical procedures?

A. The simplest and cheapest way to control excessive sweating is to use an over-the-counter anti-perspirant, which usually contains an aluminium-based compound. Its effect is temporary, so you may need to reapply it. The frequency of reapplicationdepends on the brand you use and the intensity of your sweating but most people need to use anti-perspirants only once a day.

If this fails to control your symptoms adequately or if you encounter problems with the topical agent (skin irritation is an uncommon side effect), iontophoresis may be considered.

In this method, a mild electric current is conducted through water in contact with the affected skin.

There are many such devices which you can find and purchase on the Internet. This treatment is appropriate only for your palms and feet. Each session takes about half an hour. Initially, it is done daily, but this would gradually be reduced to weekly sessions for maintenance.

Side effects are uncommon.

Alternatively, you may consider seeing a doctor for botulinum toxin A injections. Almost any area of the body where excessive sweating occurs can receive these injections, which are delivered to the affected skin at 1cm to 2cm intervals.

Each treatment session should provide a near-complete arrest in sweating, with the effects able to last for about six months.

The main risk of botulinum toxin A injections is temporary paralysis of the underlying muscle. Possible consequences include weakness of one's hand grip (if injections are delivered to the palms) and asymmetry of the upper face (if injections are delivered to the scalp). Each treatment generally costs more than $2,000, especially for large areas, such as the scalp.

Sometimes, dermatologists prescribe oral medication, such as glycopyrrolate or propantheline, for very severe sweating.

These are anticholinergic agents, which block the nerve receptors of a neurotransmitter called acetylcholine.

Therefore, this medication may affect systems which contain nerves that transmit this chemical. Possible effects are palpitations, dry mouth, blurred vision and constipation.

If you engage in strenuous physical activity under the sun, beware of heat stroke as this medication shuts down sweating everywhere in the body.

The only surgical treatment that you may consider is for your palms. It is known as endoscopic thoracic sympathectomy.

In this procedure, which involves general anaesthesia and keyhole surgery through your chest wall, nerves arising from the spinal column are selectively ablated.

The outcome on your palms is usually immediate and permanent.

But up to about a third of patients may suffer a paradoxical increase in sweating in other parts of the body.

For more information, visit the International Hyperhidrosis Society's website at www.sweathelp.org/en.

DR DERRICK AW Senior consultant at the University Dermatology Clinic at National University Hospital

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