no sweat!

by Jenny Bryan

If you're tired of guessing which celebrities have had Botox treatment to make them look younger, check out their armpits at awards ceremonies and premiers and see who's staying dry. Botox isn't just smoothing out the wrinkles these days, it's doing away with ugly sweat stains.

© Getty

Sweaty armpits used to be something no one talked about, explains Cheshire cosmetic physician, Dr Roy Saleh, but the discovery that Botox can stop embarrassing sweating means that a growing number of people are seeking help.

'Treatments for sweating used to be based mainly on deodorants and anti-perspirants,' he says. 'But we know that Botox is safe and effective, so we are able to improve the lifestyle of many of our patients with this debilitating problem.'

Dr Saleh started using it only on those with the most severe sweat problems. They were always wet under their arms and only had to think about sweating to feel it trickling down their arms.

Having seen the effects of Botox, Dr Saleh now uses it for more cosmetic sweating, for example, in people who don't want to sweat when they lecture or give presentations. But he advises against stopping all sweating.

'I tell people I'm going to try and make them normal but they need to be able to sweat a little,' he says.

why we sweat

Sweating is the body's cooling mechanism and is essential to everyday life. Across the skin are some 2-5 million eccrine sweat glands which produce thin, salty sweat. This sweat doesn't smell. But, in hairier parts, such as the armpits and groin, there are apocrine sweat glands which release stronger sweat. This contains fatty acids and other substances that bacteria like to feed on, and it is these microbes, not the sweat itself, which makes people smell if they don't wash regularly.

Everyone has a different threshold for acceptable sweating. Some are embarrassed at the faintest 'glow', while other soldier on with shirts and socks that are wringing wet. Champion sweaters lose about 10ml of fluid an hour from their armpits, and dermatologists see people whose hands get so sweaty that they cannot hold a glass of wine.

sweat busters

Zinc salts are the drying agents in most anti-perspirant deodorants. They dissolve in the sweat to form plugs which block the pores and reduce the amount of sweat that is released.

Drugs can be used to switch off sweat glands but they make other glands dry up too, for example, in the mouth.

The most desperate sweaters have had surgery to remove sweat glands or destroy the nerves that made them overactive. But results are often disappointing. Botox has the advantage that the effect is temporary. The nerve endings that are knocked out by the toxin resprout, so the effect wears off after about six months.

injecting

Botox treatment for sweating typically involves about 12 small injections to each armpit. The best sites for the injections are identified by swabbing the armpits with iodine and dusting them with powder to see which areas are sweatiest. The needle doesn't go deep, and Dr Saleh likens it to the discomfort of plucking eyebrows. The toxin blocks messages from the nerves to the sweat glands. So even if the nerves are telling the glands to release sweat, they don't respond.

In skilled hands, the injections knock out enough sweat glands to get rid of embarrassment, but leave sufficient working to ensure that normal sweating continues. Intriguingly, there is evidence to suggest that Botox reduces body odour too, but no one is quite sure why.

Dr Saleh also injects palms and fingers for those with severely sweaty hands, but he draws the line at feet. He explains that great care is needed to ensure that muscles aren't affected by the injections. Sweat-free hands aren't a lot of use if you can't move your fingers, and the potential for movement problems are even greater if feet are injected with toxin.

That's not to say that sweaty feet will always be left out in the cold. Ten years ago, neurologists who used botulinum toxin to relieve twitches and spasms dismissed the idea of using it for cosmetic reasons. A decade on, and no self-respecting cosmetic clinic would be without it.

help and info

Why not check out relaxation and breathing on our complementary medicine site. You may find the exercises helpful in reducing your sweating.

Channel 4 is not responsible for the content of third party sites.

organisations

Healthcare Commission
Finsbury Tower
103-105 Bunhill Row,
London EC1Y 8TG
Tel: 020 7448 9200 (switchboard 8.30am-6pm)
E-mail: feedback@healthcarecommission.org.uk
Website: www.chai.org.uk/Homepage/fs/en
The independent inspection body for both the NHS and private and voluntary healthcare, set up to regulate and improve standards in healthcare services throughout England and Wales. It also acts as an independent review body for NHS complaints.

NHS Direct
Helpline: 0845 4647 (24 hours)
Website: www.nhsdirect.nhs.uk
Provides expert health advice from trained nurses. An extensive database of medical information is available on the website. They can also advise you if you wish to make a complaint about the NHS.

General Medical Council
Regent's Place
350 Euston Road
London NW1 3JN
Tel: 0845 357 8001 (general enquiries) (Mon-Fri 8am-5.30pm)
Tel: 0845 357 0022 (doctors' fitness to practise)
E-mail: gmc@gmc-uk.org
Website: www.gmc-uk.org
Holds general and specialist registers of doctors practising in the UK. The registration department can provide registration details of specific, named doctors, free of charge. Contact them to check if the doctor or surgeon you have chosen is on their register.

Medical Advisory Service
PO Box 3087
London W4 4ZP
General Medical Helpline: 020 8994 9874 (Mon-Fri 6-8pm)
Men's Health Helpline: 020 8995 4448 (Mon, Tues, Thurs 7-9pm)
E-mail: info@medicaladvisoryservice.org.uk
Website: www.medicaladvisoryservice.org.uk
Telephone advice and information service for all general medical enquiries. See the website for details of other helplines.

websites

Embarrassing Problems – Sweating excessively
www.embarrassingproblems.com/sweating.htm
Informative site about sweating and excessive sweating. Describes the various options available and has details of useful contacts.

Excessivesweating.org
www.excessivesweating.org
American-based site which contains information and resources about excessive sweating to help educate people who have problems with, or may know someone who has a problem with, excessive sweating. Discusses different treatments from home remedies to surgery.

The Sweating Website
www.sweating.co.uk
This site deals with hyperhidrosis (excessive sweating) and looks at what this condition is and treatments available. Produced by a consultant vascular surgeon.

reading

'Botulinum Toxin Type A in Treatment of Bilateral Primary Axillary Hyperhidrosis: Randomised, parallel group, double blind, placebo controlled trial' by M Naumann and N J Lowe in BMJ 2001; 323: 596 (15 September) http://bmj.bmjjournals.com/cgi/content/abstract/323/7313/596

(March 2003, resources updated January 2005)