HEALTH & FITNESS

NO SWEAT

This is what Brandon Burg cherishes most: paying a dermatologist $1,000 twice a year to inject him with one of the most poisonous toxins on earth. Jab, jab, jab. His physician punctures his skin nearly three dozen times and inserts 100 units of the botulism toxin directly into Burg's armpits. "Without a question," says Burg, "it's absolutely worth it."

No, the 32 year-old consultant's mental faculties are not in need of medical attention. Rather, it's Burg's overactive sweat glands that have driven the San Francisco man to the brink of desperation. One of the estimated 2 million Americans who suffer from hyperhidrosis, or excessive perspiration, Burg has tried nearly every treatment available in order to dry up his skin. Extra strength deodorants were a flop, blood presure medications worthless. In his quest to slow the sweat glands that could soak his shirts in minutes, Burg even opted for liposuction and a type of electroshock treatment that was "total witchcraft," he says.

And so, in a last ditch effort to avoid additional surgical interventions, Burg agreed to receive injections of Botox, a purified form of the deadly bacteria that has been used successfully to treat eye spasms. It works in hyperhidrosis sufferers by preventing the release of a chemical messenger in the body that stimulates sweat glands. And because relatively small amounts of the botulism toxin are injected into - rather than ingested by - patients, doctors say the treatments are not deadly.

Still, the measure might seem a bit extreme to some, given that excessive sweating is neither debilitating nor fatal. And not only is the procedure expensive (and not covered by insurance), but also its effects are only temporary.

The condition, which typically first appears in sufferers during puberty, can wreak a great deal of havoc on social lives. Profusely sweaty palms can be a turn-off to virtually everyone around. "It's really hard to imagine never holding your girlfriend's hand or never dancing with anyone," he says. "It can really be devastating."

In a society that exalts the business handshake, however, wet palms can be more than a social nuisance - they're a workplace liability. Sales people need to greet potential new clients. Executives need to extend their hands to sign off on new deals. And job applicants must shake hands with those who have the power to hire them. "As superficial as it seems, hands so wet they seem to have just come from a faucet hinder a person's chances of making a positive first impression", says Dr. Richard Glogau, a clinical professor of dermatology at University of California - San Francisco, who injects patients with Botox regularly.

And in many cases, excessive sweat can directly interfere with a person's ability to fulfill work responsibilities. Doctors have treated secretaries whose wet hands made it difficult for them to type, machinists whose excessive sweat would rust their tools and high-tech workers whose hands would slip around in laboratory gloves.

Although it is not known what causes the condition, hyperhidrosis involves the nerves leading to the sweat glands firing at a faster rate than normal, Glogau says. Some factors, such as stress, heat, pain, exercise, caffeine and nicotine, can trigger sweating spells. "But they could be sitting contentedly reading a book and, wham, it just starts gushing," says Glogau.

Because many of those who have the condition are too embarrassed to talk to a doctor about it, researchers say it isn't known exactly how common hyperhidrosis is. Some doctors estimate that one in 1,000 people has the disorder, while others believe that as many as one in 100 does.

HEALTH & FITNESS

NO SWEAT

STARTING TOO STRONG. When deciding upon treatment, a good dermatologist will view your various therapy options as a ladder, says Richard G. Glogau, M.D., a clinical professor of dermatology at the University of California at San Francisco. "We'll begin on the first rung to see what benefit you can get from, say, a topical treatment", he says. "But if this doesn't get results, we'll move up the ladder."

Steer clear of a physician who starts out on the top rung of the treatment ladder. For example, to improve mildly sun-damaged skin, a series of Derma Peel procedures is much less invasive than a deep chemical peel. "In a Derma Peel, abrasive crystals are moved over the suface of your skin, gently removing the outer layer," says Dr. Glogau. "In contrast to a chemical peel, it can be administered during your lunch break, it's reasonably priced and it can be done on all skin types." When treating acne, your dermatologist should also start slow. "A good doctor would never initially give a patient with mild or moderate acne a powerful oral medication like Accutane, which is a strong antibiotic that can cause birth defects if the woman taking it becomes pregnant," says Dr. Glogau. "First try a topical treatment, then a milder oral prescription, such as tetracycline, a safer option that can be just as effective as Accutane."

THINKING NEWER IS ALWAYS BETTER. It's easy for doctors to hype new procedures, but don't be seduced by miraculous-sounding results. Take a new crop of injectable agents that are being used to erase fine facial lines. "For many years, bovine-collagen injections have been used effectively against wrinkles and, unlike these new solutions, they have a long-term safety record," says Dr. Glogau. Before undergoing a procedure, ask how long it has been used to treat your problem. "If it's fewer than 10 years, investigate what technique was used before it," says Dr. Glogau.

BEING COLOR BLIND. A dermatologist must take a patient's skin tone into consideration when treating. "Procedures such as dermabrasion, laser peels, chemical peels and laser hair removal can result in discoloration for darker-skinned women," says Dr. Glogau. The Fitzpatrick skin-type system classifies complexions from one to six [one being a fair-skinned, blue-eyed redhead snd six being a very dark-skinned African American]. But, explains Dr. Glogau, "it's impossible for doctors to pin a skin type to a specific ethnic group. So ask your dermatologist to give you an idea of your Fitzpatrick skin type and the discoloration risks yu'll be taking with any procedure you're considering."

BOTCHING BOTOX INJECTIONS. Administering Botox shots can be difficult, because it requires prceise injections into small areas of the body. The shots work by paralyzing muscles with botulinum toxin for three to eight months. If injected properly, Botox is a safe and effective way to visibly reduce crow's feet and forehead wrinkles. But if your shots are administered by a novice, warns Dr. Glogau, they may not work or you could temporarily end up with droopy eyelids or an asymmetrical expression.

If you're planning on having Botox treatments, Dr. Glogau recommends looking out for this warning sign: Grouping Botox shots on one day is a clue that a a doctor doesn't do large volumes of injections and may not be skilled at the procedure. [The toxin loses its effectiveness with time, so doing batches of patients is more cost effective.]