The process of sweating is controlled by the Sympathetic Nervous System. This involuntary nervous system maintains the five million or so sweat glands throughout the body. Excessive sweating or hyperhidrosis often develops in the teenage years for most patients. The most commonly affected areas are under arms (armpits), hands and feet. There are people who also develop a sweating problem on their face or scalp. Yet others complain of uncontrolled sweating in their groin area. There are also people who suffer from severe sweating throughout their body. This is sometimes refereed toas generalized hyperhidrosis compared to focal hyperhidrosis which can affect one or more particular body part. It is thought that hyperhidrosis is caused by genetic factor. Individuals with a sweating problem, either have an excess number of sweat glands in a particular area or have overactive sweat glands. In fact, some studies show that up to two-thirds of our body’s sweat glands are located in the hands alone in some people. The answer to the problem of hyperhidrosis lies within the nerves that innervate the sweat glands to make them overactive as well as increased number of sweat glands in many individuals. Doctors have found that “supercharged” or overly stressed nerves cause excessive sweating in many patients. Other sweat too much simply because they have too many sweat glands, which may be more concentrated in certain areas like the groin, the armpits or the hands.
Over the past two decades, several different approaches have become popular to address this socially and functionally embarrassing problem. Herbal medications, and many advertised lotions, which promise to end excessive sweating have no scientific merit. The surgical approach to this problem were invented about 60 years ago but, due to the location of the sympathetic nerve chain in the body, surgical procedures necessitate a very invasive surgery with many potential side effects. The operation is done either through the neck, chest cavity, or through the back. Those invasive methods have become increasingly unpopular due to many side effects the most common of which is compensatory sweating, where a new sweating problem starts in a new body area originally not affected by this condition. Since the introduction of minimally invasive surgery about 20 years ago, methods were developed to access the sympathetic nerve chain with minimally invasive surgery. However, the issue of compensatory sweating still continues to be a major side effect many of these surgical procedures. Luckly in the past 25 years, noninvasive procedure such as Botox injections and the miraDry procedure have solved the problem of sweating for many patients with minimal side effects.
Double board-certified dermatologist & laser surgeon, Dr. Rokhsar uses non-invasive treatments to reduce excess sweating or hyperhidrosis at his NYC and Long Island offices.
While doctors don’t know why excessive sweating starts, the most likely cause is a genetic one. Studies have successfully linked excessive sweating to over-activity in the sympathetic nervous system. Specifically, it is the thoracic Sympathetic Ganglion Chain, which runs along the vertebra of the spine inside the chest cavity which is the main culprit. This chain controls the glands responsible for perspiration throughout the entire body.
Other patients may simply have too many sweat glands in a particular area like the armpits, the groin, the hands or feet. The sweat glands can be mainly concentrated in the palms of the hands or soles of the feet. In most cases, the hands and feet are the only areas are affected. In other patients, the face, armpits, or the groin regions are affected as well. Another manifestation of hyperactive sympathetic activity can be facial blushing.
It used to be a common thought that excessive hand sweating is caused by overactivity of the thyroid gland but over the years it was proven not to be the case. Another thought was that patients who suffered from anxiety problems would have excessive hand sweating. This was proven to be wrong as patients can have severe palmar Hyperhidrosis (hand sweating) even in the most relaxing moments of their life. Patients with hyperhidrosis can have sweating in the armpits, feet, groin, or the face and scalp, even when they are completely relaxed.
Simple self-help measures you can take include:
Botox injections can be a game changer for many NYC patients who suffer from hyperhidrosis. When small doses are injected into the skin, Botox blocks the actions of the nerves that stimulate the eccrine glands. This prevents the glands from producing sweat. The effects of treatment can last for several months but will eventually wear off.
Using a very fine needle, Dr. Rokhsar will inject small amount of solution into 10 to 15 places about 1 cm apart and spread evenly in each armpit hands or feet. Dr. Rokhsar uses very small needles making the procedure tolerable. The treatment takes less then 5 minutes. Most patients start seeing results within a few days after Botox injections. Results can last 3-9 months depending on the anatomic area injected and the patient’s degree of sweating.
The effects of treatment will become fully apparent within 2 weeks. Patients tend to return for their next treatment on average every 3-9months. The effects of Botox will wear off over a period of several months. If you decide not to have more treatment there will be no lasting change in the areas treated and sweating will gradually return to the level it was before you started treatment.
miraDry is a new and innovative solution to hyperhidrosis. Dr Rokhsar has been doing performing the Miradry procedure for more than a decade. He has performed more miraDry treatments than any other physician in the country. This treatment significantly reduces sweating in the armpits on a long-term basis only after two treatments for a majority of patients. There is no need to worry that this might be unhealthy as the rest of your body sweats more than enough to make up for any reduction in your armpits. miraDry uses electromagnetic energy to target and destroy the sweat glands. This is long-lasting because the sweat glands don’t grow back. The procedure is painless as the armpits are completely numbed beforehand. The treatment takes approximately half an hour foe each under arm. The effects are immediate, with reduced sweating noticeable the next day. It may seem that some sweating returns a few weeks later, but this is simply the leftover sweat glands which continue to produce more sweat. Two treatments are necessary in most patients to further decrease the number of the sweat glands.
There is some swelling afterward, especially the night of and the next day, so icing the areas as much as possible is recommended. The treated areas will also be sore but are easily alleviated with some ibuprofen. However, neither the swelling nor the soreness is the degree that a patient cannot return to work the next day. Some swelling and discomfort might persist for one to two weeks. The armpits will also feel bumpy to the touch, possibly for up to one month. This is a natural part of the healing process.
Dr Rokhsar is considered a world authority on the miraDry procedure. He has helped develop miraDry protocol and has trained many doctors around the country. He has published scientific articles as well as many book chapters on this topic.
Dr. Rokhsar is the first miraDry provider in New York with the greatest experience in the tri-state area.
Hyperhidrosis is a medical condition that refers to excessive sweating beyond what is necessary to regulate body temperature. It can cause a physical burden and negatively impact one’s quality of life from a psychological, emotional, and social perspective. The condition can be inherited, resulting from a mutation in genes, and can also be a result of other medical conditions. Symptoms of hyperhidrosis can include sweating that soaks through clothes or drips off hands or feet or groin, which can cause social anxiety and embarrassment. The condition can lead to social isolation and withdrawal from others in fear of body odor and damp clothing which can show through stains in the underarms and groin. In case of hands with excessive sweating, patients may have social anxiety shaking hands or touching people or even holding a pen and writing. In case of feet with hyperhidrosis, patients may have wet shoes or even slip on floors when walking because of excessive sweating and wetness of feet.
Hyperhidrosis affects different areas of the body, including the underarms, palms, soles of feet, face, forehead, and head, but it usually affects only specific parts of the body, known as primary or focal hyperhidrosis. In most cases, the condition occurs for no apparent reason. People with primary focal hyperhidrosis usually begin to experience the condition during childhood or adolescence, and the cause is not related to other medical conditions.
Excessive sweating can be treated using different methods, including antiperspirants, medications, Botox injections, miraDry and surgery. One such surgery is sympathectomy, which involves cutting or destroying certain nerves to stop the nerve signals that the body sends to the sweat glands. This surgery has many complications with the most common being compensatory sweating, which is paradoxical sweating that starts in other parts of the body. Botox injections are the preferred method of treatment for hands, feet, face, forehead, and scalp. miraDy is considered the best option for treatment of sweating in the underarms or arm pits. Results with miraDry are dramatic and permanent. It is essential to speak with Dr. Rokhsar about the best treatment options for your individual case of hyperhidrosis.
Primary focal hyperhidrosis is a chronic skin disorder that results in excessive sweating in certain areas of the body, such as the armpits, hands, feet, head, face, scalp, inguinal, and inframammary areas and groin. The condition is also known as idiopathic hyperhidrosis and is thought to be caused by increased cholinergic activity on eccrine sweat glands. Primary focal hyperhidrosis is a relatively common disease that is inherited from family members through a mutation in their genes. It usually begins early in life or during teenage years and is characterized by excessive sweating in amounts greater than what is needed to regulate body temperature. Unlike secondary hyperhidrosis, which is caused by an underlying disease, primary focal hyperhidrosis occurs for no apparent reason.
The most commonly affected areas in primary focal hyperhidrosis are the armpits, hands, and feet, but it may also affect other areas of the body such as face, scalp, forehead, and the groin area. This condition can cause significant social anxiety and embarrassment, as well as disrupt daily activities. Fortunately, primary focal hyperhidrosis is treatable. Topical aluminum chloride-based antiperspirants, iontophoresis, botulinum toxin injections, oral medications, miraDry, and surgery are some of the treatment options available. Dr. Rokhsar can help you develop a personalized treatment plan that best fits your needs and manage your symptoms effectively. Dr. Rokhsar is an experienced Botox injector, who teaches the cosmetic dermatology clinic at Mount Sinai. He was also the first doctor in the New York area to offer the revolutionary miraDry procedure in the New York area which cures excessive sweating in the under arms. Dr. Rokhsar has performed more miraDry procedures than any other physician in the United States.
Excessive sweating, also known as hyperhidrosis, can be caused by various factors. Primary focal hyperhidrosis is the most common cause, which affects about 1% to 3% of the population and usually begins in childhood. This condition occurs when there is a problem with the nerves that control the sweat glands, leading to overactive glands in certain areas such as the palms, soles, underarms, and sometimes the face.
Secondary hyperhidrosis, which is less common, is caused by an underlying medical condition, such as endocrine disorders, tumors, medication side effects, menopause, infections, leukemia, lymphoma, malaria, and neurological diseases. Additionally, certain drugs and substances, such as beta blockers and antidepressants, can also cause excessive sweating.
Furthermore, heavy sweating may occur due to diabetes, heart failure, anxiety, or overactive thyroid, and some foods and drinks, such as alcohol and spicy foods, may trigger excessive sweating. Gustatory sweating, which is excessive sweating on the forehead, face, scalp, and neck after eating, may also occur.
Excessive sweating refers to sweating that is more than what the body needs to regulate its temperature. It can occur for a variety of reasons, including underlying medical conditions, medications, or emotional or physical stress. If the excess sweating is due to an underlying medical condition, it’s called secondary hyperhidrosis. Health conditions that might cause excessive sweating include hyperthyroidism, infection, diabetes, and lymphoma, among others. Sometimes excessive sweating can be a sign of a serious condition, and seeking immediate medical attention is necessary if heavy sweating is accompanied by symptoms such as chest pain, dizziness, or a rapid pulse, weight loss, night sweats, or fever.
Hyperhidrosis can affect specific areas of the body, such as the underarms, palms, feet, head, scalp, or the groin area. It may, in rare instances, affect the whole body. It may also be caused by an unknown reason, known as idiopathic hyperhidrosis. In some cases, excessive sweating can disrupt daily routines and cause emotional or social anxiety, leading individuals to seek treatment.
Excessive sweating at night, also known as night sweats, can be caused by various underlying medical conditions or medications. Some of the common medical conditions that may cause night sweats include infections like tuberculosis or HIV, autoimmune disorders such as rheumatoid arthritis, hormonal issues such as menopause, low testosterone, or hyperthyroidism, and some cancers including leukemia and lymphoma. Medications that may cause night sweats include antidepressants, hormones, and some drugs used to lower fever or treat diabetes.
Apart from medical conditions and medications, night sweats can also be caused by lifestyle factors like excess weight, alcohol, caffeine, and spicy food consumption, and sleeping in a warm room with too many blankets or a poor ventilation system.
Night sweats may be a symptom of a more serious underlying disease and should be evaluated by a healthcare provider if they occur frequently and disrupt sleep.
Excessive sweating in women can be caused by a variety of factors, including medical conditions, hormonal changes, and external triggers. One of the most common causes is primary focal hyperhidrosis, a genetic condition that affects up to 10% of the population and usually begins in childhood or adolescence.
Secondary hyperhidrosis, which is caused by an underlying medical condition or medication, can also affect women. Some of the medical conditions that can cause excessive sweating in women include acromegaly, diabetic hypoglycemia, fever of undetermined cause, hyperthyroidism, infections, leukemia, lymphoma, malaria, and neurologic diseases.
Hormonal changes, such as those that occur during menopause, can also cause excessive sweating in women. Additionally, external triggers such as warm weather, exercise, spicy foods, and anxiety can cause excessive sweating.
If excessive sweating is accompanied by other symptoms such as dizziness or lightheadedness, it may be a sign of an underlying health issue such as hypoglycemia or low blood sugar levels. Excessive sweating in the groin area can also occur due to a variety of reasons, including exercise, non-breathable clothing, and infections.
Hyperhidrosis, or excessive sweating, can be treated through a variety of methods. Here are some of the most common treatments:
The best treatment for hyperhidrosis depends on the individual case and may require a trial-and-error approach to find the most effective solution. Consulting with a board certified dermatologist like Dr Cameron Rokhsar in New York, can help determine the best course of treatment for your individual case.
There are several ways to manage and reduce excessive armpit sweating:
There are several treatments available to help manage the condition. Here are some options for treating hyperhidrosis in hands:
If you are suffering from hyperhidrosis, it is recommended that you seek medical attention to diagnose and treat your condition from a board-certified dermatologist like Dr. Cameron Rokhsar in New York. Dr. Rokhsar is double board certified in Dermatology and Dermatologic Surgery.
Dr Rokhsar has years of experience treating hyperhidrosis patients with Botox injections, miraDry, as well as topical and oral medications.
The diagnosis of hyperhidrosis may start with your primary care physician, who may ask about your medical history and symptoms and conduct a physical exam or tests to further evaluate the cause of your symptoms. Some primary care doctors are familiar with the initial treatment of focal hyperhidrosis, but it is best to seek the advice of board-certified dermatologists who are considered experts in the treatment of sweating or hyperhidrosis.
Dermatologists are doctors that specialize in the treatment of skin hair and nails, including hyperhidrosis. They may recommend treatments such as antiperspirants, prescription medications, and procedures like Botox injections, or Miradry. The International Hyperhidrosis Society also recommends choosing a dermatologist as your primary care provider for hyperhidrosis treatment.
Neurologists may also be involved in the treatment of hyperhidrosis, particularly if the excessive sweating is caused by an underlying neurological condition. They specialize in treating the brain and nervous systems, which control your sweat glands, and can also help address emotional and social issues that result from excessive sweating.
Antiperspirants are often the first line of treatment for hyperhidrosis. They work by reducing sweating and can be purchased over the counter or prescribed by a healthcare provider. Prescription antiperspirants with aluminum chloride, such as Drysol and Xerac AC, are often recommended. These should be applied to dry skin before bedtime and washed off in the morning.
Behavioral techniques, such as stress-reduction therapy, may provide relief from negative emotional reactions associated with hyperhidrosis. Lifestyle changes, such as wearing breathable clothing and avoiding triggers that cause sweating, may also help.
For more severe cases, medical interventions may be necessary. Botulinum toxin (Botox) injections can be used to block nerve signals that trigger sweating in the face, forehead, scalp, head, hands, feet and under arms. The best treatment option for excessive sweating for underarms or armpits is the Miradry procedure. The Miradry procedure after two sessions will stop your sweating by an average of 80% on a long-term basis. Dr. Rokhsar has performed more miradry procedures than anyone else and is considered a world expert in the treatment of sweating with MiraDry. Dr. Rokhsar also treats groin sweating with Miradry as an off-label procedure (miraDry is currently FDA approved for treatment of axillary hyperhidrosis) Other medical interventions include oral medications, such as anticholinergics and beta blockers, iontophoresis (a procedure that uses electrical current to reduce sweating), and Qbrexza wipes.
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Dr. Cameron Rokhsar, MD, FAAD, FAACS, is the founder and medical director of the New York Cosmetic, Skin, & Laser Surgery Center. Dr. Rokhsar is a graduate of Harvard College and NYU School of Medicine. Dr. Rokhsar is double board certified in dermatology and micrographic dermatologic surgery, being one of the few select dermatologists in the country who is also fellowship trained in laser surgery. A researcher and innovator, Dr. Rokhsar is the creator of the non-surgical nose job and has been instrumental in the research and development of laser systems such as the Fraxel, CO2, Mirady, Vbeam, Themitight, and Ulthera devices. An Associate Professor of Dermatology at Mount Sinai Hospital in NYC, Dr. Rokhsar actively teaches the cosmetic dermatology clinic to the resident at Mount Sinai. An expert injector of fillers, and a trainer for many companies, patients fly in from around the world to see Dr. Rokhsar in his Garden City and Manhattan offices in New York.
Dr. Rokhsar was chosen by
magazine as a top dermatologist in its Best Doctors 2017, 2018, 2019, 2020, 2021, 2022 and 2023 issues.
