Fourth grade wasn’t the average elementary school year for Heather Maltbie.
Instead of playing games with her friends during recess, she avoided group activities. She wore gloves year-round, telling her friends that her hands were always cold. And she routinely carried handkerchiefs in her pocket so she could easily wipe her hands.
Maltbie, who at age 9 was diagnosed with hyperhidrosis, a condition that causes excessive sweating in the hands and feet, worked hard to disguise her condition.
“I always told everyone I just washed my hands,” said Maltbie, now age 21. “I knew it was sweat, and I didn’t want to get teased for it.”
Hyperhidrosis is a common condition that affects more than 6 million people in the United States. Many people are unaware they have it. Because the disorder’s cause is still unknown, doctors are only able to treat the excessive sweating rather than the overactive glands themselves.
Maltbie started using topical creams and wipes to keep her sweating under control, a frustrating trial-and-error process that never completely dried her palms. After going through puberty, her family physician suggested she try oral hormone medication as a second-phase treatment, which was a slight improvement.
“I just learned to live with it and manage it,” Maltbie said. “All the sweating was inconvenient, but I got good at recognizing when it would happen, and ultimately, I thought it was just another weird quirk people might have.”
After high school, Maltbie moved to Columbia to live with her father and to attend the University of Missouri. In the middle of her sophomore year, Maltbie had an adverse reaction to the oral medication, leaving her hospitalized and in need of an alternative solution.
“When I wasn’t able to take the oral medication, my hands were constantly dripping with sweat,” Maltbie remembered. “When I’d be taking notes in class, they would smudge. I always wore dark colors and breathable fabrics like cotton to wipe my hands off on and help disguise all my sweat. It was embarrassing.”
She began to see dermatologists Jonathan Dyer, MD, and Kari Martin, MD, who worked together to offer her personalized options.
“When topical and oral medications fail, we move to the next tier of treatments for hyperhidrosis patients,” Martin said. “Patients at MU Health Care, like Heather, have both medical and surgical options available to them, which is something unique.”
Dyer and Martin suggested the medical route for Maltbie with two options — Botox injections or iontophoresis. Botox would require a shot ever centimeter, almost 100 shots per hand, every four to six months until her body allows for less frequent injections. Iontophoresis treatment would require submerging her hands and feet into a shallow bed of water with electrical current for 30 minutes three times per week.
Maltbie ultimately decided to try the Botox injections.
“It feels like a bubble of burning pressure, like burning oil under my skin,” Maltbie said. “It was just as painful as you can imagine, and my hands were black and blue for a few days afterwards.”
But the payoff was worth it.
“The day-to-day benefits, the tiny little things I didn’t even know I was missing out on, have been worth it,” Maltbie said. “Small things like handing over money to a cashier without the bills being soaked through or talking on my phone without sweat dripping down my arm. I don’t have to think about it anymore, and I am no longer embarrassed.”
While Martin and the dermatology clinic see hundreds of patients with hyperhidrosis each year referred from all areas of Missouri, Maltbie sticks out in Martin's mind for her determination to feel normal.
“Even though the Botox injections make her feel kind of feel crummy and very uncomfortable, Heather gets so much benefit out of it and pushes through each treatment,” Martin said.
Maltbie will have to return in late summer for her next round of injections, but for now, she no longer has to worry about always wearing dark clothes or trying to hide her hyperhidrosis.
“It’s been a miracle,” Maltbie said. “It’s been really cool getting to enjoy my hobbies without sweating. I can finally knit without soaking the fabric or shake hands with someone without apologizing for mine being wet.”