Past Advice
1702 users have voted.
Tip #
Options to treat excessive sweating (hyperhidrosis)

Hi Everyone:

Excessive sweating is known as hyperhidrosis. Sometimes it’s very severe, sometimes it is just perceived as severe…but either way, it’s a problem. There is no known cure for hyperhidrosis unless it’s due to an underlying illness such as hyperthyroidism or other illnesses. Despite this, there are several treatment options that can lead to successful outcomes. Below I discuss these treatments in order of aggressiveness.

For axillary (armpit) hyperhidrosis, I would recommend starting with over-the-counter (OTC) clinical strength antiperspirants. They provide some help over regular strength antiperspirants by creating a small plug to decrease the outward flow of sweat onto the skin. Brands include Arrid, Degree, Dove, Certain-Dri, Gilette, Hydrosal, PerspireX, Secret and Sure.

Treatment with a topical solution containing aluminum chloride should be your first step in treating sweating of the palms, feet, scalp and your next step in combating axillary hyperhidrosis. Like clinical strength antiperspirants, these solutions also create a plug that decreases sweat outflow. The strength of the aluminum chloride solution ranges from 10% to approximately 50%. It is sometimes used in combination with salicylic acid in a gel form. For underarm sweating, I recommend the lower concentrations of 10-15% due to the potentially irritating nature of this treatment (armpit skin is very sensitive), and higher concentrations for excessive sweating of the hands and feet. These should be applied at night to completely dry skin. I recommend blow-drying the area on the warm (not hot) setting before application. Extreme caution must be used with increasing strength. After it’s applied, I recommend blow-drying the applied area again but on a cool setting, so that the alcohol in the solution evaporates. I also recommend wearing a t-shirt if you are applying it to your underarms, and if you are using it on your hands or feet, use cling wrap over the applied area under mittens or socks. This will increase the efficacy of the treatment and also avoid the solution getting on your sheets. Wear a shower cap if you’ve applied it to your scalp. Do not apply to irritated or abraded skin or after shaving. Once you’ve done this for several nights in a row, weekly use is recommend to maintain the effects of the treatment. If irritation develops, discontinue use of products with the solution until the irritated area has totally recovered. Drysol, Hypercare and Xerac AC are common OTC brands that you could try.

Iontophoresis is an effective treatment for excessive sweating that requires a doctor-prescribed machine. The machine passes a safe mild electric current into the skin. It does not hurt but can tingle or sting. However, it is a bit annoying to use. To start out with, it takes about ten daily 20-40 minute sessions. Weekly maintenance treatments every 2-3 days are needed to sustain the effect. Iontophoresis is typically recommended for the hands and feet. It’s more difficult to use for the armpits and irritation is more common when used there. Drionics and Fischer are two machine brands that could be purchased.

Besides being used for wrinkles, headaches, muscle spasms and many other medical conditions, Botox, which requires a visit to the doctor, can be used as a highly effective treatment for hyperhidrosis. The best areas on which to use Botox are the armpits and scalp. Injecting it in these areas doesn’t really hurt. It can also be used for hands and feet. The down side of using it for the hands and feet is that it hurts to inject it in these areas so sometimes a “nerve block” to numb the area is used which leaves you numb for several hours. It is also possible that when Botox is used in the hands it can cause some temporary weakness of the hand muscles. So it may not be ideal for anyone who relies on fine motor skills such as nurses. This effect is not seen in the armpits and scalp. The biggest downside of Botox is the cost, which can run into the hundreds or even thousands of dollars if it is not covered by insurance. Allergan, the manufacturer of Botox, has recently instituted a program where the cost of the Botox is free for your first hyperhidrosis! This does not cover the cost of the injection but that is often covered by insurance. So if you are interested in trying Botox for hyperhidrosis, now is the time!!!!

Anticholinergics such as robinul (glycopyrrolate) are another effective treatment for excessive sweating. This treatment can actually be a life changer for some. I mention it after the above treatments only because it’s an oral pill and therefore has potential systemic side effects. In the U.S. you have to get a prescription from your dermatologist. The great thing is that because it’s a pill it’s easy to use and it will treat hyperhidrosis anywhere you have it. So, if you have excessive sweating in your hands and feet, for instance, it will treat both areas! Because it’s not target specific, however, it can actually dry you out everywhere, so side effects such as dry mouth and eyes are common. But, in my experience, most patients find this a minor inconvenience and are usually willing to put up with these side effects. It is by no means is a cure and you will still sweat, just not as much. Because the effects don’t last all day for some, you may have to take it more than once a day. The dose typically ranges anywhere from 1-2 mg 1-3 times a day and you usually have to titrate the dose and frequency to what works best for you.

Finally, there’s surgery. However, I must stress this is a last option and the outcome is not always a good one. There are two options for surgery. The first, axillary resection, is used for excessive sweating in the armpits and can cause scarring or decrease arm mobility. Lastly, endoscopic sympathectomy is a surgical procedure where a sympathetic chain is cut or disrupted resulting in decreased sweating. Although it can be highly effective it often results in compensatory sweating which means sweating somewhere else usually on the trunk, buttocks or thighs significantly increases. I have seen this side effect on many occasions and it can be devastating to patients so I highly discourage this procedure.
1901 users have voted.
Tip #
Your video questions please…and some important reminders!

Hi Everyone:

Thanks for all of your great comments and questions over the past few months! I’ve enjoyed reading them and answering as many as time has allowed for me.

Today I’d like to try something different. You’ve heard from me by video—now I’d like to hear from you the same way! If you have a question that you would like to ask me and you’re willing to post a video to my facebook page, I’ll pick a few of your videos and respond directly to them. Please keep the videos limited to one specific question and keep them brief (less than 30 seconds). Please begin by stating your first name and where you are from.

In the meantime, I’d like to leave you with a few simple reminders that I cannot stress enough. Number 1: Healthy skin is not achieved with a quick treatment or two—it is obtained through a healthy lifestyle over years and decades. This healthy lifestyle starts with applying sunscreen to your face, neck and chest every morning as a part of your make-up routine. Do not rely on SPF in your make-up or moisturizer. And number 2: make sure to check your skin frequently for any new or changing moles. A mole does not have to be raised in order to be a melanoma. In fact, the majority of early melanomas are flat, not raised.

I look forward to your video questions!
1769 users have voted.
Tip #
One of the most common facial rashes in women: “perioral dermatitis”!

Perioral dermatitis is an acne-like rash around the nose and mouth and sometimes around the eyes. Although it often has little pimples scattered around the nose, mouth, chin and less frequently around the eyes, it can look more “rashy” with red, dry, scaly patches or both the pimples and dry patches. Although it is an easy diagnosis for dermatologists, it is often misdiagnosed by good doctors in other fields because it can look like so many other things such as acne, eczema, seborrheic dermatitis, etc. The problem is that some acne medicines such as retinoids, benzoyl peroxides, etc. can make this rash worse. And medicines to treat eczema or seborrheic dermatitis such as steroids, including OTC hydrocortisone, will seem to initially make the rash better, but eventually the rash flares because steroids are actually “fuel for the fire” when it comes to perioral dermatitis.

Perioral dermatitis almost always affects women and children but is rarely seen in men. We are not sure what causes this rash, but it may be products used on the face in some cases. Whatever the cause, the great news is that this rash is curable—which is not to say the rash will never come back…it can but usually years later if it does.

Treatment of perioral dermatitis is fairly straight forward but requires you to discontinue topical steroids if you are using them. The best treatment is oral antibiotics such as minocycline, doxycycline or tetracycline (TCN is difficult to get) but other antibiotics such as azithromycin are also effective. These oral antibiotics usually take care of the rash within a few weeks at most unless steroids have been used for a long time. Topical treatment with antibiotics such as topical erythromycin, clindamycin or metronidazole are also effective but work much more slowly.

So if you have persistent annoying acne or dry rashy skin around your eyes or mouth, consider the fact that you may have perioral dermatitis.
1197 users have voted.
Tip #
Start early protecting your neck from the sun!

One of the most telling places of a woman’s age is her neck. It is, unfortunately, extremely difficult to treat once damage from the sun has been done. Dermatologists call the neck an “under privileged” area. That is because unlike facial skin, the skin on the neck has relatively few adnexal structures such as hair follicles and sweat glands. These are the structures that help us heal. So healing of the neck after a procedure is slow, and aggressive treatment with lasers or peels to minimize the effects of sun damage and the aging process is risky. Another unfortunate thing about the neck is that young women often forget about the importance of protecting their necks from the sun. By middle age, when significant sun damage has already occurred and starts to become visible, many women will finally start their sun protection regimen of this area. It’s never too late but the earlier you start protecting your neck, the better it will look later in life!

Typically, women’s necks really get hit quite hard by the sun. Why? Because we don’t apply make-up which may have some SPF on our necks, and our necks are exposed to the sun year round, with or without hats and often even with protective clothing.

I have a couple of very important recommendations. The obvious recommendation is to start every morning by putting on your sunscreen before you get dressed so that you can apply it to your entire neck and upper chest without having to worry about getting it on your clothing. But my recommendation is not for sunscreen alone, although this is a critical daily product as I have just mentioned. I also recommend getting two inexpensive versatile fashion scarves. I would keep a larger one in your glove compartment or central console of your car and another smaller one in your purse. The amount of sun your neck gets while you are driving around is incredible! If you spend just 20 minutes a day driving around when the sun is in the sky, you will have 120 hours of sun exposure on your neck per year and that doesn't even count the hours that you are out walking around during the day! This is the reason for the scarf in the car. Next time you are driving around with your sun visor pulled down in your car to protect your eyes and face from the sun, look in the rear view mirror and notice that the sun is still shining on your neck. Trust me, I've tried all angles and twisted sitting positions to try to avoid the sun from getting on my neck and it just doesn't work. So I went to using a scarf when the sun is hitting my neck in the car. I have a really large one so sometimes I’ll even drape it over my arms. It’s second nature to me now and I hope it becomes so for you! PS, the purse scarf is for when you are in situations when you are forced to be in the sun and you have no options for shade. It’s like emergency sunscreen that doesn't expire.
1115 users have voted.
Tip #
Why do I have acne scarring and what can I do about it?

Acne scarring can be devastating! Many people call the discoloration left by acne “acne scarring,” but this discoloration, which can persist in some cases for over a year, is not really scarring and will eventually go away. True acne scarring is when the texture of the skin, not the skin’s color, is disrupted. Unlike discoloration left by acne, true acne scarring is considered permanent. Even though it may appear otherwise, true acne scarring is not a surface phenomenon. Instead, acne scarring takes place below the surface of the skin in the dermis. So, don’t waste your money on microdermabrasion, peels, creams or other topical treatments that will not get to the root cause of the problem.

“Ice pick” acne scarring is considered a small focal indentation. It is typically best treated by cutting out the scar. You will still have a scar, but the scar won’t be indented. It will be flush with the surrounding skin and much less noticeable. Undulating, or wavy, acne scarring is more difficult to treat. If it is widespread, you may benefit most by something radical, such as full facial resurfacing, which is similar to a deep burn with months of recovery. Fractionated lasers that drill holes at intervals in the skin may be helpful as well. Typically the results are not quite as dramatic, but it is a much easier treatment to go through. If a scar is not “tethered down” from below it should be able to be pulled out by stretching the surrounding skin. If this stretching of the surrounding skin makes the scar disappear, that scar may be a good candidate for using filler below the scar. Sometimes, a combination of these treatments may work. Regardless of the treatment, however, these are typically relatively difficult treatments to go through.

Although I know many of you were hoping for a miracle cream, it just doesn’t exist! And I stress that you should not waste your money on creams that profess to help acne scarring—I can promise you they don’t. And if anyone has tried a cream that has actually helped with acne scarring, I would bet that that scar was not a true scar or the scar would have improved on its own.