Hyperhidrosis
Medical Author:
Alan
Rockoff, MD
Medical Editor:
Frederick Hecht, MD, FAAP, FACMG
Medical Reviewer: Melissa Conrad Stöppler, MD
Hyperhidrosis Treatment
Medical Author: Nili N. Alai, MD, FAAD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR
Hyperhidrosis is excess sweating. While sweating is a normal human bodily
function, some people naturally sweat more or less than others. Some individuals
sweat in excess, causing problems with school, work, and social situations. Hyperhidrosis affects both males and females and can start at any age. It is
often a severe and emotionally distressing problem for people with the
condition. Effective treatments are now available to help those with
hyperhidrosis.
Treatments for hyperhidrosis include over-the-counter antiperspirants,
prescription antiperspirants like Drysol (20% aluminum chloride), iontophoresis,
pills like glycopyrrolate (Robinul), and surgery. Robinul may be reserved for special occasions like school dances, job
interviews, weddings, proms, anniversaries, first dates, and other really
important events.
Top Searched Hyperhidrosis Terms
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iontophoresis
What is hyperhidrosis?
Hyperhidrosis, or excessive sweating, is a common disorder which produces a
lot of unhappiness. An estimated 2-3% of Americans suffer from excessive
sweating of the underarms (axillary hyperhidrosis) or of the palms and soles of the feet
(palmoplantar hyperhidrosis). Underarm problems tend to start in late
adolescence, while palm and sole sweating often begins earlier, around the age 13 (on
the average). Untreated, these problems may continue throughout life.
Sweating is embarrassing, it stains clothes, ruins romance, and complicates
business and social interactions. Severe cases can have serious practical
consequences as well, making it hard for people who suffer from it to hold a
pen, grip a car steering wheel, or shake hands.
What is the cause of hyperhidrosis?
Although neurologic, metabolic, and other systemic diseases can sometimes
cause excessive sweating, most cases occur in people who are otherwise healthy.
Heat and emotions may trigger hyperhidrosis in some, but
many who suffer from hyperhidrosis sweat nearly all the time, regardless of their mood or the
weather.
Hyperhidrosis Treatment
Medical Author: Nili N. Alai, MD, FAAD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR
Hyperhidrosis is excess sweating. While sweating is a normal human bodily
function, some people naturally sweat more or less than others. Some individuals
sweat in excess, causing problems with school, work, and social situations. Hyperhidrosis affects both males and females and can start at any age. It is
often a severe and emotionally distressing problem for people with the
condition. Effective treatments are now available to help those with
hyperhidrosis.
Treatments for hyperhidrosis include over-the-counter antiperspirants,
prescription antiperspirants like Drysol (20% aluminum chloride), iontophoresis,
pills like glycopyrrolate (Robinul), and surgery. Robinul may be reserved for special occasions like school dances, job
interviews, weddings, proms, anniversaries, first dates, and other really
important events.
Top Searched Hyperhidrosis Terms
treatment,
sweating,
night sweats,
Drysol,
axillary hyperhidrosis,
palmar hyperhidrosis,
non surgical treatments,
antiperspirant,
plantar hyperhidrosis,
Botox,
iontophoresis
What is the treatment for hyperhidrosis?
Through a systematic evaluation of causes and triggers of excessive sweating,
followed by a judicious, stepwise approach to treatment, many people with this
annoying disorder can achieve good results and improved quality of life.
The approach to treating hyperhidrosis generally proceeds as
follows:
- Over-the-counter
antiperspirants -- usually tried first because they are readily
available. Antiperspirants containing aluminum chloride (for example,
Certain-Dri) may be more effective when other antiperspirants have failed
- Prescription strength antiperspirants -- those containing aluminum chloride hexahydrate
- Iontophoresis -- a device
which passes direct electricity through the skin using tap water
- Oral medications -- ones
called anticholinergics which reduce sweating
- Botox (botulinum toxin) --
recently approved in the U.S. by the FDA for treating excessive axillary
(underarm) sweating
- Surgery -- cervical
sympathectomy, as a last resort
Aluminum chloride hexahydrate
When regular antiperspirants fail, as they often do, to remedy hyperhidrosis most doctors
start by recommending aluminum chloride hexahydrate (Drysol), a
prescription-strength version of aluminum chloride. It is applied just before
bedtime seven to 10 nights in a row, then roughly once a week thereafter to maintain
improvement. This treatment works reasonably well for many patients whose
problem is excessive underarm sweating, but is not satisfactory for most of those with palm
and sole sweating.
The main side effect with Drysol is irritation, which can sometimes, but not always,
be overcome by reducing the frequency of use or applying antiinflammatory
medications such as lotions containing hydrocortisone.
Iontophoresis
Iontophoresis was introduced over 50 years ago as a treatment for excessive
sweating. Its exact mechanism of action is still unclear. The procedure uses water to conduct an electric current to the skin which combats production of sweat. Current is applied typically for 10-20 minutes per session, initially with two to three sessions per week followed by a maintenance program of treatments at one- to three-week intervals, depending upon the patient's response. Iontophoresis treatments sound potentially painful but, in fact, they
are not.
Patients purchase devices for this treatment through a doctor's prescription.
Medical insurers sometimes cover the cost.
Oral Medications
Oral anticholinergic medications such as
glycopyrrolate (Robinul) are not commonly used for this condition, because in order to work they often produce
side-effects like dry mouth and blurred vision.
Botox
Botulinum toxin (Botox), a muscle
poison much in the news as a cosmetic treatment for wrinkles,
has actually been used in many areas of medicine for some time, such as in the
treatment of muscle spasms, and certain types of headaches. Its latest medical
niche is the treatment of excessive underarm sweating.
Fifty (50) units of Botox are injected into roughly 20 spots in each
armpit. This may produce approximately six months of relief from sweating. The
injections are uncomfortable, but use of a very small injection needle makes
them tolerable.
Now that this treatment has received FDA approval, many
health insurers are
providing coverage for the injections and the Botox itself, which is quite
costly.
Currently, the FDA has not approved Botox for treating sweating of the palms
and soles of the feet, though some physicians are administering it as an
off-label use, reportedly with success. Palm injections cause more pain,
requiring nerve blocks to numb
the hands in order to make the injections comfortable.
Surgery
Thoracic sympathectomy is surgical
interruption of the sympathetic nerves responsible for sweating. Sympathectomy
is an operation intended to destroy part of the nerve supply to the sweat glands
in the skin. The surgeon inserts a special endoscopic instrument into the
chest between two ribs just below the armpit. The lung is briefly deflated to
better visualize and destroy the nerves. Sympathectomy is both effective and risky.
Even with newer endoscopic techniques, the complications can include excessive
sweating in other parts of the body and lung and nerve problems. As many of
these complications are serious and not reversible, this option is rarely used,
and then only as a last resort.
- Hyperhidrosis, or excessive sweating, is a common
disorder.
- Axillary hyperhidrosis is excess sweating of the
underarms.
- Palmoplantar hyperhidrosis is excess sweating of the
palms and soles.
- Hyperhidrosis usually occurs in people who are
otherwise healthy.
- The approach to treating hyperhidrosis generally
proceeds from OTC antiperspirants to prescription
antiperspirants, iontophoresis, oral anticholinergic medications, Botox, and
surgery.
Last Editorial Review: 3/16/2007
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