How to Stop Excessive Sweating: Botox, Body Odor & Sweat Acne Tips from a Dermatologist | Dr. Idriss

Sweating is absolutely normal and it is your body's way of keeping you alive. But, here's the big but, if you're sweating through your clothes or if you're worrying about how you smell or if you're planning your outfits around your armpits, maybe we need to have a different conversation because if you feel like you cannot wear light-colored clothing, light grays, silks, form-fitting outfits because of your sweat situation, maybe there's something more going on with you and it's not just that you run hot. But I do wanna reassure you by telling you that A, you're not alone. It is a relatively common thing for people to be concerned about. And I am a cosmetic dermatologist who sees people with this concern nearly every week throughout the summer. By the way, who the hell am I and where did you land? I'm Dr. Shereene Idriss. I'm a board-certified dermatologist based in New York City. And you landed on Pillow Talk Derm, where we do this thing every Saturday morning at 10:00 AM. If you haven't subscribed, subscribe below. Like this video, follow along. Let me know what you wanna learn about. But today we are gonna be talking about— Sweat. Sweat. And we're gonna be breaking down why we sweat, what exactly is hyperhidrosis, AKA when we sweat through clothing, what's the clinical diagnosis, why does it happen? We're also gonna understand how, for example, Botox can help your sweating situation, why body odor happens, because body odor and sweat are tightly linked, why sweat can also trigger acne, folliculitis, heat rash, friction bumps, you name it. And last, Mm-hmm. What you can actually do about it. We're gonna be going through every single one of these, so let's dive in. So why is it that we sweat? And sweating is a very natural process. It's been with us since the beginning of time, and it is our body's built-in AC system. It's gonna cool us down. When the temperatures rise, when we get hot, we release this watery secretion, AKA sweat, onto the surface of our skin, and as it evaporates, our temperature starts to cool down. And sweat can be triggered by heat, heat waves, it can be triggered by exercise, it can be triggered by stress and anxiety and spicy foods, but also fevers, like your body temperature is going up, your body's trying to regulate itself. So as you get hotter and hotter, you sweat it out. So you're trying to cool your body from the outside in. Hormonal changes, not just in puberty, but perimenopause and menopause, and yes, certain medications and spicy foods. But it's important to recognize that sweat itself is not dirty and it doesn't actually smell, which is very, very interesting because people often think that if you sweat, you stink. Oh. That's not true. The problem with sweat is what happens after the fact, once the sweat is out of the glands, because if it is produced in excess, if it gets trapped under your skin or underneath a really tight-fitting shirt, if it is interacting or mixing with bacteria, oils, body lotions, sunscreens, products on your skin, or if it's creating a lot of friction and irritation, that's when the subsequent problems can happen. How can you help yourself when the sweating situation is starting to take a mental toll on you but also affecting you in a social setting. There are two types of sweat glands. Not all sweat glands are created equal, and I just want that to be very clear. And I want you to think of your sweaty palms. When you get really, really hot and your palms are starting— and you get nervous and your palms are becoming really, really watery and you smell your palms, do you smell sweat? The answer is no. There are a specific type of sweat gland known as an eccrine sweat gland. Eccrine. Sweat gland that happens to be all over the body, yes, to help regulate our temperature, but it tends to really be more prominent on your palms, your soles. Yes, you have them in your underarms and your scalp and your face, but the type of sweat that they release is a very watery secretion, and you could think of your sweaty palms as an example of that. But you also have apocrine glands, which tend to be much more localized in areas where hair grows, and they show up after puberty, hence why you start to stink in puberty, but in your underarms and in your groins and the type of secretion with an apocrine gland, once that comes out of the gland and it starts to interact with the bacteria on the surface of your skin, it can release a musk and a certain odor and a certain je ne sais quoi. But it's important to recognize that not all sweat smells and not all smelly people sweat a lot. So it's an interesting conundrum, but I just need you guys to differentiate that. Because before you go in with harsh antibacterial washes and soaps to try to get rid of your body odor, it's super important for you to understand what is considered normal. So normal versus excess sweating. Normal sweat happens when you're hot, when you're nervous, if you're working out or if you're stressed or if it's really, really— you're stuck in a hot subway in the middle of July in the middle of New York City, you're going to sweat. It's your body doing its job and you're gonna sweat pretty much everywhere. But guess what? You're gonna stop sweating once the conditions improve and the trigger goes away. That's how you know that you are AKA quote unquote normal sweating. But if you feel like your sweat is out of proportion, like your palms are so sweaty you can't even grasp a pencil, or you're wearing sandals that can't stay on your feet, or you can't wear socks because you basically sweat through your socks, or you are sweating so profusely that you can literally see see it and feel sweat drops coming from the top of your scalp, down your face, and even dripping down your chin, that is a condition known as hyperhidrosis, increased hydra— hydration, water— sis, production of water. So, common areas of hyperhidrosis include your palms, your feet, your hands, your scalp, your groin, even your face, plus your chest and your back. Primary hyperhidrosis tends to be excessive sweating within specific areas, like your palms or your feet, and there tends to be a genetic link where someone else in family may also be suffering from this condition as well. It's not necessarily caused by another medical condition, whereas secondary hyperhidrosis, profuse sweating all throughout your body to the point where you are absolutely drenched, can occur due to other underlying conditions, whether it is medications, hormones, thyroid imbalance, endocrine imbalance, other medical conditions, even underlying cancers. Not to scare you, but for you to be aware because— Mm-hmm. Sweating is your body's first sign of something else going on, and it's important that you keep yourself aware as to what are your sweating patterns, because if they suddenly change, it is worth you going to get that checked out to make sure that nothing has shifted or there's no growing tumor inside of your body, especially if those sweats happen at night and you drench through your PJs or your bedsheets, and you are also losing weight. So I would not ignore that sign. Sign. But there are topical treatments, and we're going to review a few that can help you manage your sweat, starting with over-the-counter antiperspirant versus deodorant. Now, these two words are often used interchangeably, but the interesting thing is when you think of deodorant, it is deodorizing you. It is getting rid of the odor by masking it. And so it's really a fragrance-heavy product. And what I found is in people with certain scent, who tend to have heavier, stronger body odors, it's not really doing them any favors. Then you have antiperspirants. They're going to anti-perspire you, meaning they're going to fight your body's way of sweating by creating tiny little plugs in your sweat glands so your sweat gland activity is reduced. I don't think you need to worry so much because you're going to have other sweat glands that are not plugged and therefore you're going to— your body is a very smart thing and it can overcompensate. But first line over-the-counter products that I would recommend if you are somebody who has hyperhidrosis and you're finding that you don't want to go to social gatherings that are taking place outside or you just get stressed by them because you sweat, I would look at CertainDri. It's a prescription, it's a prescription strength over-the-counter product that doesn't require a prescription. I'm not sponsored by this company, by the way. That is made up of 15% aluminum chloride that creates a tiny little plug in your sweat gland So it reduces the sweat activity of that gland, and therefore you do not have as heavy sweat marks in your underarms. You can also get the spray version of this product, especially if you're somebody who tends to sweat, let's say, on your back with larger body surface areas. You can use it there as well. The best way to use these is to apply them at night and to reap the benefits the next day. So at least it could take a few hours for it to form those plugs to start working on your body, and therefore minimizing your sweating patterns. Other products that are available over the counter is the Z-Azorb Excess Moisture Control Powder, which is best for moisture, friction, and sweat-prone folds like under your boobs, your— in the little fold between your thigh and your pelvic area, your groin, your feet, your skin folds underneath your stomach. This does not stop sweat production, so you're not blocking it and you're not masking the scent, but it is going to absorb the moisture. It's almost like a wick, helping to reduce the friction and helping to support your skin barrier. So I would apply it to clean, dry skin after you shower. But if there is a persistent drainage, odor, rash, I wouldn't keep applying powder over it. I would get that evaluated. Prescription options if over-the-counter antiperspirants are not enough. Number 1, you can get a stronger aluminum chloride solution at 20% via prescription. This is known as Drysol. It's like certain dry but prescription strength. And it's funny, in my practice, I always call the over-the-counter one Drysol. It's not funny, but I get them confused all the time. But you can literally apply this to your soles, to your underarms, to your underboob, in areas where you are constantly sweating. And there's another prescription, also known as Cubrexa, which is glycopyronium cloths that you can literally wipe in your underarms for hyperhidrosis. It works slightly differently than aluminum chloride. It instantly reduces the sweat at the surface and it helps to block the chemical signal that is pushing the sweat glands to release sweat. It is for underarm use only and you need to wash your hands after applying it because you don't want to put it on your palms and then rub your eyes. And it should be prescribed by a medical provider. Now, there is also glycopyrrolate, an oral medication that we can prescribe that is going to basically, if you know that the body has a fight or flight mode, and it has a resting mode, it kind of pushes you into the resting mode. So your sweat activity goes down overall, but so does the activity of your gut and you may get constipated. And because when you're in a resting mode, your pupils tend to be more dilated, so you may experience blurry vision and you may feel a little bit dizzy and a little bit slower. And so that has a slew of systemic side effects. In my practice, we offer, for example, any sort of neurotoxin like Botox or Dysport or Jeuveau, whichever one, for larger areas like your underarms, your underboobs, especially if you're prone to rashes. And for brides getting married this summer, we even sometimes do the hairline, especially at the back of the scalp, to minimize any sweating if you're having a wedding party outside. Which leads me to Botox for excessive sweating. And how does that work? Your sweat gland is activated by a nerve signal, and the chemical messenger that activates it is acetyl choline, and Botox temporarily blocks that signal in the treated area, minimizing sweat production in that area. So when people get their foreheads Botoxed, they don't tend to sweat from their foreheads. Or if you get Botox for migraine, you'll notice that you have less sweating on your scalp. It is an FDA-approved treatment for severe primary underarm sweating when topical treatments have not met the mark and have failed you in terms of treatment. It's an interesting option. I think with Botox, you have to just be careful at the dose, how much you're getting at a single time. Additionally, you don't want to go too deep, for example, on your palms, because you don't want to get muscle weakening in your hands. But when it's done very superficially, it can really be a game changer for many. The onset of activity usually takes anywhere from 10 to 14 days until it kicks in, and the average duration is around 3 to 4 months. But if that gets you through the hottest months of the summer, and you are able now to overcome your mental block and your social anxieties from sweating, it's well worth the investment in the summertime. It is not going to minimize how much you sweat overall. And when you treat an area like your underarms, it doesn't mean that your back is going to sweat more. Again, we are covered with thousands, if not millions, of tiny little sweat glands all over. So you're not going to feel all of a sudden being drenched in your underboob if you do your underarms. It doesn't really work that way. But the biggest risk with Botox at the injection site is tiny bruising, tenderness, local irritation. And again, like I mentioned, if you go too deep, like on the palms of your hands or your soles, you can get temporary muscle weakness. So that's why going to a really seasoned injector is essential. But it's one of those treatments that we don't necessarily jump to at the beginning, but it can really have life-changing impacts for you if this is something that is now controlling your life. Which leads me now to body odor, which can control other people's lives, especially if you're not even aware of it.. But if you are aware of it, I want you to understand why your sweat smells. So we touched on this in the earlier part of this video, and sweat and body odor are related, but they're not always the same thing because sweat itself is not something that has a smell. It becomes smelly when it comes into contact with body odor-causing bacteria, either on the surface of your skin or even in your clothing or through synthetic materials, etc. So that is why when somebody can say, "I shower every day and I don't know why by midday I stink," it's not because you're dirty or you're lacking hygiene. It just means that maybe we need to be thinking about how are you taking care of yourself to minimize those factors that might be contributing to your body odor. And this can happen from, like we said, bacteria on your skin, but also in your clothing. If you're somebody who works out and you don't necessarily change your t-shirt every single time you work out or wash it right away, and that bacteria now is growing and harboring in the clothes, that you're using. Body odor can be made worse by that bacteria buildup, by tight synthetic clothing. Like if I wear like polyester that's really, really tight, I've noticed that my sweat tends to smell worse than if I'm just wearing a regular cotton t-shirt. Not drying your skin fully, hormonal changes, perimenopause, menopause, certain foods, like if you eat a lot of cumin, you'll notice that certain people sweat If they eat a lot of cumin in their diet, smells like cumin. Broccoli also can make your sweat smell different and worse for most people. And certain medications and supplements can also affect the smell of your sweat. So that's where it's important for you guys to understand the deodorant versus antiperspirant portion of this video because the antiperspirant is gonna help to reduce the sweat activity, which is gonna minimize your overall body odor. But if you're somebody who struggles with body odor, I think certain things you could do for yourself can help you, like utilizing a benzoyl peroxide cleanser in the shower. Probably 3 to 4 times a week so that you reduce the load of odor-causing bacteria. And I would focus it in your groin and in your underarms, allowing it to sit for a minute before fully washing it off. I wouldn't just apply it and wash it because you'll be pissing your money down the drain. You can also use exfoliating acids in those harder-to-reach areas like glycolic acid. So you're breaking down the skin buildup, the keratin buildup that may be trapping the bacteria and the sweat. Mm-hmm. In your folds and making your sweat interact with bacteria that's been kind of hiding there. And so exfoliating is also a good way to help to renew your skin cells so that that doesn't happen. I would also say washing your clothes very regularly. If you work out, take your clothes off right away and toss them that day into the washer so nothing is building up in the seams of your clothes or in your pits, etc., of your clothing. And making sure that you're not using non-breathable synthetic materials like really heavy polyester. I have a pair of pajamas that are super cute, but those things do not breathe. And when I put them on, I start to sweat way faster because it's like trapping my body heat. And I have noticed that even with those materials, the sweat smells different. So it does definitely affect, um, all of it in one. If you have odor, but you also have a rash, and let's say you have oozing, itching, pain, drainage, flaking, I wouldn't just try to treat it with these measures. I would make sure that you get a consultation with your local board-certified dermatologist because there are many conditions that can affect your underarms and your folds, also known as intertrigo, that could be due to yeast, bacterial overgrowth, or other skin issues like even psoriasis. So I want you to have that checked out. But let's quickly talk about breakouts, bumps, and rashes caused by sweat. And I want to preface this section by saying that if you have any of the below, please make sure that you check with your local board-certified dermatologist because not every bump that you you have on your skin in a sweaty area is acne. But when you are sweating, you can tend to get sweat buildup that can contribute to bumps when your sweat mixes with certain oils, like in makeup, sunscreen, dead skin cells, tight clothing, friction, heat, and humidity. And one condition that often occurs is acne mechanica, also known as sweat acne, where you get these tiny little bumps in areas that have been occluded, where the sweat is now trapped under the surface of the skin and the friction is working to make your pores get even more clogged and to irritate your skin. So think under your sports bra or along your waistband, or even if you wear a baseball hat, along your forehead. I've seen it, you see it a lot, especially in the summer, you get tiny little bumps on the surface of your forehead. Tight workout clothes on your chest or your upper back if you're wearing a sports bra. So this is not that your skin is dirty, it's because that sweat is getting trapped in with the oil, the products, and the friction. And so you want to, number one, reduce any of the bacterial load on your skin so you don't want to make it into acne. So I'm talking about benzoyl peroxide wash. Additionally, salicylic acid is the type of exfoliating acid that I would use in those areas because you want it to go into oil-producing areas that tend to be more concentrated, like on the forehead and your face, and that's definitely going to help. Plus, using a retinol to help to exfoliate and to help regulate your cell turnover more regularly is also going to help contribute to lessening those bumps. But your own habits matter. So if you wear a really tight sports bra, take it off after working out and don't just sit around the house with it. And try not walking around with a really tight hat or baseball cap. The second condition is known as folliculitis. So folliculitis is an inflammation of the hair follicle when your sweat glands basically are blocking your hair follicles. And one interesting clue with the folliculitis is you're gonna see a hair along every single single bump when you really look closely. And that is the real differentiating factor of folliculitis versus acne on your chest or back. But folliculitis itself can be worsened by bacteria or yeast, fungal acne. And therefore, it's important that you understand the patterns of these types of folliculitis by seeing a dermatologist because the treatment varies widely. Using an antifungal shampoo like Nizoral, which is available over the counter, will help with fungal folliculitis, but it will do nothing for bacterial folliculitis, which can then become full-blown acne if it goes untreated. Regardless whether you have fungal or bacterial folliculitis, you want to minimize any sort of irritation to the area because that can lead to scarring. And the scarring will be the same. And consider scarring like Rome— all folliculitises lead to Rome if you irritate it or scratch it. The third condition is known as heat rash. And this happens when your sweat ducts are blocked and your sweat cannot escape like it normally does, and it gets trapped with tiny little bumps, prickling, itching, burning. And it tends to be way more common in hot, humid environments where you're wearing really tight clothing and your folds of your skin, any area where your sweat gets trapped. And the first treatment is you need to cool your skin down. You need to let it breathe. And you need to get out of the heat as much as possible. And even taking a cool shower while after being out in a hot summer sweaty day can really, really be helpful. But keeping the area dry, cool, breezy can make a huge difference for a heat rash. And avoiding actives like the benzoyl peroxides and the retinols that we talked about earlier is essential because if you put actives on a heat rash, you will blow it up and you will make it worse. So those are other conditions as well that kind of look alike but have different root causes, so they're not treated the same way. And last, there is something known as intertrigo or friction bumps, which is anywhere that a skin fold appears, the skin in that area can appear moist, can get macerated, can become soft, and can start breaking down. And in those areas, you can develop secondary infections like candidal infections or bacterial infections. But intertrigo alone can be caused by other underlying issues as well, like psoriasis, seborrheic dermatitis, dermatitis, you name it. And it's important that you keep your skin nice and dry and you try to treat the primary cause. But if there's no primary cause, an intertrigo happens because a fold is very, very thick and heat gets trapped and it becomes very, very humid in there, then you want to ideally keep that area dry. Hence why utilizing the antiperspirants in those areas or getting a treatment in office that's localized to those areas can make a huge difference. huge difference for you so that you don't get those rashes, like for example, under your boobs. Inner Trigo treatment add-ons include keeping your skin clean and dry, like we talked about, using moisture-absorbing powders like the Zeosorb, barrier support when your skin is rubbing, like a basic bland barrier ointment like zinc. Another thing you could do that I tell patients is literally to take a Kleenex and to keep it underneath their bra so it can help, but ideally something that has a moisture-wicking property and not just a Kleenex. Is even better. And if there is itching, redness, or any pain, make sure that no yeast is involved. So, when to see a dermatologist? If it's interfering with your mental health, if it's interfering with your social life, if it changes all of a sudden and it's associated with weight loss, if you are noticing other systemic symptoms, and if there are secondary changes to the skin beyond the sweating in terms of pain, drainage, itch, you name it, I would go see a dermatologist to make sure that nothing else is going on and so that they can help you lead more confident, fuller, less sweaty lives. I hope this video was helpful. If you guys are enjoying these longer format videos, please let me know below. I think I'm losing my voice, but it is the weekend so we can rest up. I hope you guys have a beautiful Saturday and I will see you guys again next week, but this upcoming week I am going to be in Paris with my kids for their summer vacation trip. So I will see you guys all when I get back. Bye!