Long-Term Acne/Hyperhidrosis

[Books15]

Dr. Rockoff,

I am a 23 year old male from Canada.

I've suffered from severe sweating since the onset of puberty and also had severe acne as a teenager. For acne, I was prescribe 6 months of accutane - which did wonders for my facial/body acne. However, in the last couple of years I have struggled with controlling back acne. For sweating, when I was 20 I received botox injections in my forhead and armpits - which worked well. Not amazingly, but helped for sure. I had been getting injections every 6 months. However, in the last year and a half I haven't received any injections as I have moved away from home (where my dermatologist was located)

It is clear that hyperhidrosis has played a large role in my acne problems.
What suggestions do you have for treating my back acne? It is pretty severe and I am worried about scarring. Its almost as if a lot of the acne is permanent. Should I return to accutane?? Or do you have other suggestions?
Is there anything more I can do to treat my hyperhidrosis more thoroughly? Do you know if botox injections for hyperhidrosis are limited to forheads/hands/feet/armpits? Or could I receive them in other places such as my nose or back?
Are there any more comprehensive solutions (ie. surgery) for hyperhidrosis? I'm willing to do almost anythign at this point - it really is paralyzing my life.

[Alan Rockoff, MD]

Actually, acne and hyperhidrosis have nothing to do with each other, even if you have both.  For your back acne, a dermatologist could consider oral antibiotic therapy or perhaps another course of Accutane.  Botox is an excellent treatment for armpit sweating.  It may also be helpful for sweating of the hands and feet, but requires blocking the nerves on the region to minimize pain, and may be associated with temporary muscle weakness.  I have not heard of its use on the forehead.  There is a "comprehensive" treatment for sweating, namely sympathectomy, cutting the sympathetic nerves in the spine.  As you can imagine, this can cause permanent damage, and must be undertaken only with the greatest caution.  Bottom line: please consult a US dermatologist about all these options, get as many opinions as you need, and then proceed judiciously.

[Books15]

I appreciate your prompt answer. I will consult with some dermatologists (although I live in Canada) One final query: In terms of the relationship between acne and hyperhidrosis: for myself, since I sweat so much from the word go, I find the reason my back has such problems with acne is that, although I'm very hygienic, I'm not able to constantly keep my back clean from clogging my pores and as a result, over the course of the day my pores will clog and thus the acne. Is this logical reasoning on my part or is this not possible? What are some causes for severe back acne? Thank you again for this remarkable service.