By Peggy O'Farrell
Enquirer staff writer

Thanks to Botox, Cara DiPuccio can wear long-sleeved shirts.

The drug best known for curing forehead wrinkles is the latest hope for people like DiPuccio who suffer from excessive sweating, or hyperhidrosis.

HYPERHIDROSIS

Hyperhidrosis is a medical condition characterized by excessive sweating, even when the person isn't overly warm, anxious or exercising. The condition most often affects the hands, feet and underarms, but other areas can also be affected. Other facts: • People with hyperhidrosis struggle to manage the condition by changing clothes several times a day; bathing frequently; stuffing paper towels or pads in the armpits; constantly wiping sweaty hands on clothing; hiding their hands; buying dark-colored clothing; and avoiding shaking hands and speaking in public. • Treatments for hyperhidrosis include over-the-counter and prescription antiperspirants containing 10 percent or higher concentrations of aluminum chloride hexahydrate; iontopheresis, or the use of a low electrical current to temporarily block the sweat glands; some medications; surgery to interrupt nerve signals to the sweat glands in the hands; and Botox injections to prevent excessive sweating in the underam area. • Some medical conditions can also cause excessive sweating, including hyperthyroidism, diabetes, some anxiety disorders, some cancers, neurological conditions, chronic infection, menopause and spinal cord injuries. Source: The International Hyperhidrosis Society

HOW DO THEY STAY SO COOL?

Never let them see you sweat. Some folks can't help it, but others just naturally seem to possess an icy calm that repels the very thought of perspiration. Among the coolest: • Martha Stewart. Even a trial and an upcoming prison stint couldn't dampen the domestic diva's brow. • Sean Connery. On and off the red carpet, the quintessential James Bond never seems shaken or stirred. • Barry Bonds. He set a record 30 home runs in 13 consecutive seasons without breaking a giant sweat. • Donald Trump. Knows how to keep his billion-dollar cool even when those around him are apprentices at business.

The 22-year-old Hyde Park woman was "11 or 12" when the excessive sweating started. "It was horrible," she says. "It was bad enough that if it was cold in the winter, I would be sweating buckets," she says. DiPuccio would even sweat through sweatshirts, and could only wear sleeveless shirts in white or black, she says.

Last month, the Food and Drug Administration approved Botox, a weakened form of the toxin that causes botulism, to treat primary axillary hyperhidrosis, or excessive sweating of the underarms. The drug apparently works by paralyzing a nerve that stimulates the sweat glands.

Before the FDA approval, many doctors, including DiPuccio's, had used Botox "off label" to treat excessive sweating.

She's been getting Botox shots for about two years."It's the most amazing thing to be able to get up in the morning and not be sweating," she says.

Dr. Gene Ireland, a plastic surgeon at the Plastic Surgery Group in Fairfax, where DiPuccio is a patient, cites one study in which 91 percent of patients who received Botox reported their sweating reduced by at least half.

"It's very much the treatment of choice" for excessive sweating of the underarms, Ireland says.

OK only for underarms

Botox is approved for use only in the underarm area. Some people with hyperhidrosis suffer excessive sweating of the hands, feet or face, or all over the body.

When over-the-counter antiperspirants don't work, prescription antiperspirants are the typical first-line treatment. But there's a warning: they can cause skin irritation, redness, and stinging.

In some cases, medications such as antidepressants, tranquilizers, and a type of high blood pressure medication known as calcium channel blockers are prescribed, since they may have a "drying" effect.

Surgery is another option.

Wendy Fannin Welsh of Portsmouth had surgery to control excessive sweating of her hands. Her feet also sweat excessively.

Welsh, a paralegal, often has to carry legal documents to the courthouse across the street from the law office where she works.

Before she had the surgery, she says, the papers would be soaked with sweat by the time she delivered them.

She would always try to wear jeans or dark slacks so she could wipe her hands.

Shaking hands was also a problem.

"That was something else, especially in the legal profession," she says. "Everybody shakes hands all the time. I hated it. I tried to avoid it, but you don't want to appear rude."

Surgery not cure-all

The surgery means she doesn't have problems with her hands anymore. "I don't have to shape my life around it," she says. "I've never looked back."

The surgery involves making two small incisions on both sides of the body between the second and fifth ribs, says Dr. John Howington, a thoracic surgeon with the University of Cincinnati. Tiny clips are inserted through the incisions and attached to the nerves that stimulate sweat glands in the underarms and hands. Clamping off tiny sections - 2 to 3 centimeters - of the nerves blocks off the signals to sweat, Howington says.

The surgery isn't as successful in controlling excessive sweating in the face or feet, but works well for the hands and underarms, Howington says.

Another option is surgery to remove sweat glands under the underarms. DiPuccio was considering it when she learned about Botox.

She has to get Botox injections every three to six months, and the cost for both arms is about $400.

"To me, it's worth it," she says.

E-mail pofarrell@enquirer.com