Hyperhidrosis
Medical Author:
Alan
Rockoff, MD
Medical Editor: 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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palmar hyperhidrosis,
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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 around puberty, while palm and sole sweating may begin
earlier, often during childhood. Untreated, these problems may continue
throughout life.
Sweating is embarrassing, it stains clothes, and it 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 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.
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: Home remedies like these are 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. So-called "natural" antiperspirants are often not very helpful.
- Prescription-strength antiperspirants: those containing aluminum chloride hexahydrate
- Iontophoresis: a device
which passes direct electricity through the skin using tap water
- Oral medications: from the group of medications known as anticholinergics, which reduce sweating
- Botox (botulinum toxin): 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,
various generics), 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. The aluminum salts in this preparation
collect in the sweat ducts and block them. Over time, sweating may diminish to
the point at which little or no further treatment is needed. This method works
reasonably well for many patients whose problem is excessive underarm sweating,
but it's not satisfactory for most of those with palm and sole sweating.
The main side effect with aluminum chloride 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.
The 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 painful but in fact 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, insomnia, 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
use is for treating 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 minimizes
discomfort.
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, with some success. Drawbacks of using this treatment for the palms and
soles are pain, requiring nerve blocks to numb the hands in order to make the
injections tolerable, and the potential for temporary muscle weakness.
Surgery
Endoscopic thoracic sympathectomy (ETS) refers to 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, complications of the procedure can include excessive sweating in other parts of the body as well as 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.
Previous contributing editor:
Frederick Hecht, MD, FAAP, FACMG
Last Editorial Review: 4/24/2009
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