Hyperhydrosis sweaty underarms, sweaty palms, sweaty face Solution 2022 | Miradry vs Botox |

Botox

Hyperhydrosis in common areas

With our increasing hot and humid weather, and global warming, sweating seems to be ever present these days. From sweaty underarms, to sweaty palms, sweaty feet and sweaty face, we as a nation, are getting more and more drenched. So what are the options to heavy perspiration? Let us explore.

How is Miradry vs botox for hyperhydrosis?

Based on price – Miradry is at 2.5k SGD vs 1.5k SGD for botox.

Based on pain – Miradry involves the thermolysis of sweat glands, hence it can be uncomfortable and requires numbing cream. Botox for hyperhydrosis, when done with the right technique, can feel like a pinch, and does not require any numbing cream.

Based on efficacy – Miradry is a 1 off treatment limited to your underarms, while botox for hyperhydrosis lasts 6 months on average. Miradry can only be done for sweaty underarms, while botox can be performed for sweaty underarms, sweaty palms, sweaty soles, and sweaty forehead and scalp.

Based on safety profile – miradry gives a downtime of swelling, bruising for 2 weeks, while botox, if done in the right plane, gives little to no downtime.

Preparation Protocol

•             First, the hyperhidrotic area is dried and an iodine solution is painted on and allowed to dry. -> Alt? How long?

•             Corn starch is then sprinkled on the area and allowed to sit. -> Alt? How long?

•             Purple-black dots develop when sweat interacts with the starch and iodine. ->  How long?

•             Use a marking pen to create evenly spaced injection markings as a template for BoNT-A injections. -> How? Why? Where?

Painting with Iodine

Starch Iodine Test

Marking


Special: Botox Reconstitution

— 
1. Each 100 U vial of onabotulinumtoxinA should be reconstituted with 4 mL of sterile 0.9% non-preserved saline solution (50 U-2 mL). Painful so how?
2. The total injection volume (4 mL)

—  3. To minimize patient discomfort, the needle should then be replaced with a higher gauge (e.g. 32-guage) needle for injection.

—  4. The physician will need to divide 50 units evenly among the injection sites, per axilla.



Administration Protocol

•             OnabotulinumtoxinA is injected slowly and carefully into the intradermal plane of each axilla. Avoid puncturing the skin exactly at the ink dot of your marker. Why?

•             Physicians should try to obtain a visible wheal

•             Hold compression to facilitate hemostasis. -> Why?

Intradermal Injection – This requires good technique to minimise bleeding and bruising.

Patient Assessment and Follow-Up

•                     Patients can expect results in 1 week.

•                     Based on clinical trials, relief from excessive sweating of the axilla for 6 mths.

•                      Studies have found that 25% of the patients may experience relief for up to 12 months.

•                     If after two weeks, excessive sweating persists -> Y? 

Body Site || Percentage of Patients

—  Do u know the top 3 commonest areas?

Epidemiology | North America

—  Body Site || Percentage of Patients

—  Axilla 73.0

—  Palms 45.9

—  Soles 41.1

—  Face or scalp 22.8

—  Groin 9.3

—  Others 9.6

Special areas

—  1. forehead +/- scalp

—  2. palm

—  3. soles

References

1. Lear W, Kessler E, Solish N, et al. An epidemiological study of hyperhidrosis. Dermatol Surg 2007; 33(s1):S69–75.

2. Glaser DA, Hebert AA, Pariser DM, et al. Facial hyperhidrosis: best practice recommendations and special considerations. Cutis 2007;79(Suppl 5): 29–32. 3. Rystedt A, Swartling C, Naver H.

3. Anhidrotic effect of intradermal injections of botulinum toxin: a comparison of different products and concentrations. Acta Derm Venereol 2008;88(3):229–33.

Stay dry.

Stay sweat free.

Use Botox.

Dr Daniel Chang
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