Every once in a while, a patient will ask me about possible treatments for excessive sweating, the medical term for which is "hyperhidrosis" (HID). More specifically, they usually ask about primary axillary hyperhidrosis (excessive armpit sweating). This may not sound like a serious problem, but for those who suffer with it, this can cause significant impairment. It can cause social problems as well as employment/occupational difficulties.

In the past, various remedies have been tried for this condition, including topical agents, oral medicines, and even surgical interventions. None of these have been uniformly effective, leaving these sufferers with few alternatives and much frustration.

Recently, some clinicians have advocated the use of botulinum toxin type A (BTX or botox) for this condition. Theoretically, this makes some sense. BTX is a neurotoxic protein, produced by the Clostridium botulinum. It is one of the most poisonous substances in the world, and is potentially deadly in very small amounts.

BTX exerts its effects by decreasing muscle activity. This happens at the junction between the nerve ending and the muscle fiber. BTX blocks the action of a neurotransmitter, acetylcholine, at this junction. The effects can last up to 4-5 months. This explains why the agent is useful for the reduction of facial wrinkles. It causes the underlying muscles to relax and stop working, resulting in a softer, smoother countenance.

Theoretically again, this should work in the armpit. The process of sweating comes from the release of moisture from glands located throughout the body, and especially in the armpits. This release is caused by the activation of these glands by the same neurotransmitter, acetylcholine. Hence, BTX blocks the acetylcholine which blocks the sweating. Should work.

In fact, it does. A study published in the Journal of the American Academy of Dermatology (2007;56:604-611) looked at a large group of people with significant HID symptoms. They found that 75% of them reported a major improvement in their symptoms, which they defined as at least a 50% improvement in a standardized questionnaire. On average, this positive effect lasted for more than 6 months, and there were no significant adverse effects. These results are impressive, and better than a lot of therapies used for a wide range of problems.

So, when Sure doesn't do it, and a container of baby powder doesn't keep you dry, remember this info, and ask your doctor about it.

On a different but equally fascinating note, I want to share some information I came across considering "napping". This has nothing with the snooze we all look forward to on Sunday afternoon. Rather, it involves the taking of regular naps and the effect this may have on your health.

The Archives of Internal Medicine (2007;167:296-301) published a study that looked at this issue. The authors followed a large group of people (23,681) for more than six years, and categorized them as to their napping practices. There were 3 groups:

1) Those who never napped

2) Those who systematically napped (midday naps at least 3 times a week, with a duration of at least 30 minutes)

3) Those who occasionally napped (irregularly, once or twice a week, with a duration of less than 30 minutes)

Their findings were remarkable and significant. Compared to those who never napped, if you were an occasional napper, you lowered your risk of cardiac death by 12%. If you were a systematic napper, you lowered your risk by as much as 37%. That's an important reduction. Interestingly, they found that age did not change this association, and that men who worked enjoyed a greater reduction in cardiac death than those who didn't.

This study will stimulate further research in this area and more definitive information will be forthcoming. But for now, napping seems to be a positive thing for most of us. Hmm. What time is it? I can't wait to get started. And if you want to come by the office and get some advice about this, just ask for me at the front desk and...zzzzzzzzzzzz.