Truncal hyperhidrosis is ruining my life. What are my options?

Question

I am 36 yo woman, tall, lean and fit. I eat healthy. I have had hyperhidrosis of the groin and inner thigh, butt for the last couple years. It used to be only during hot months but now it's nearly all around the clock and year. My crotch is a furnace, soaks through clothes and is ruining my life. Prescribed topical treatments don't do a damn. What are my options? Botox? VATS? Please help. I rarely sweat in any other area.

Anil R. Shah, MD · Answer

Hello, there are a variety of ways to combat excessive sweating.

Botox- Botox is helpful in that it can decrease the production of sweat but not odor.  It typically lasts about 6 months in the under arm area.
Miradry-  Miradry uses microwave energy to destroy apocrine and eccrine glands.  It is better at eccrine gland destruction than apocrine and is currently only used on the underarm area.
RF needling- Can be used anywhere on the body and can destroy both apocrine and eccrine glands.  Has become the procedure of choice in my practice for hyperhidrosis due to its effectiveness.
Nerve ablation-Not commonly performed anymore as side effects are often worse than treatment and effectiveness is often limited.
Oral medications- Too many side effects to be effective.
Topical medications- Works by blocking glands.  Many patients state how not effective mechanism.

Best,
Anil Shah

Kenneth Hughes, MD · Answer

Botox is a very effective treatment in those areas and can provide months of relief. Kenneth Hughes, MDBeverly Hills, CA

Raffy Karamanoukian, MD, FACS · Answer

I have coauthored a book on hyperhidrosis and would recommend controlled amounts of Botox injections for truncal sweating.  Results are temporary but work very well. Best, Dr. Karamanoukian Los Angeles

Sheila S. Nazarian, MD · Answer

Botox injections are the only currently available product for sweaty palms, feet, groin or scalp. Miradry is currently approved for permanent elimination of sweat and odor glands in the underarms but they may be coming out with a new applicator for other areas.My best,Sheila Nazarian

Reza Momeni, MD, FACS · Answer

VATS will not work for this region since the nerves are not in the chest cavity for this sweat area.  Botox injections might be the most helpful option for you.

Lawrence Osman, MD · Answer

Treatment options would include a combination of topical and oral anticholinergics such as glycopyrrolate and Botox.  See an endocrinologist first, though, to rule out any underlying disorder.

Hratch Karamanoukian, MD, FACS · Answer

Read my hyperhidrosis ebooks provided on the link below. I have written 5 and discuss every treatment option available for the varioous types of hyperhidrosis. I do not recommend LUMBAR sympathectomy for men or women. In men, lumbar sympathectomy can cause ejaculatory dysfunction. In women, no such problems have been identified but there is risk of developing lymphedema in the legs, something that can cause significant disability as you age, from a medical and cosmetic standpoint. Try oral anticholinergics and if that does not help, seek someone who has expertise with Botox injections in the groin. You are not the only patient with hyperhidrosis of the groin. Botox works wonderfully in that area and will change the your quality of life indictors (QOL measurements of patient satisfaction) overnight. I recommend that you have an annual physical with bloodwork including thyroid function testing and a chest xray. I developed a comprehensive hyperhidrosis center in 1999, The Center for Excessive Sweating, and perform every type of procedure for hyperhidrosis. Th issue with you is going to be whether your health insurance company will authorize for you to get Botox injections in your groin and inner thighs. We have worked with our local insurance companies for 15 years and in patients who have insurances in our area, we have been able to get authorization and payment for treating these 'atypical' areas of hyperhidrosis. California insurances are more expensive to buy and provide less coverage and not likely to cover Botox injections in those areas. You may appeal it or pay out of pocket. There is hope as in the next several years, procedures like miraDry will be modified and FDA cleared for use in areas outside of the underarms. Read my ebooks.

Davin Lim, MBBS, FACD - Account Suspended · Answer

See a dermatologist or specialist HH doctor. I agree that sympathectomy is not advisable. Try-1. Glycopyrrolate lotion or cream 2%2. See your doctor for anticholinerics eg. Oxybutin or Propanthelene BromideBotox is not feasible given the extent, sure, 100 units can stretch out to fit two hand size areas, but costing would be prohibitive. Botox is great for isolated areas such as the underarms (this is on Medicare in Australia), for trunkal sweating, unfortunately there is no easy solution.RegardsDr Davin LimLaser DermatologistBRISBANE, Australia.

Truncal hyperhidrosis is ruining my life. What are my options?

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