Gary W. Cole, MD, FAAD
Gary W. Cole, MD, FAAD
Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
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 perspire nearly all the time, regardless of their mood or the weather.
What is the treatment of 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 improved quality of life.
The approach to treating hyperhidrosis generally proceeds as follows:
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 as a maintenance medication. The aluminum salts in this preparation collect in the sweat ducts and block them. Over time, the excessive perspiration may diminish to such an extent that 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 anti-inflammatory medications such as lotions containing hydrocortisone.
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.
This new device produces microwaves that presumably destroy sweat glands while preserving other tissues. Treatments occur in a physician's office and in recent studies have been accompanied by local swelling and irritation as well as a variety of other relatively minor side effects. Sweating seems to be significantly decreased for a time. How this device would be used in other anatomical areas aside from the armpits is not clear.
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.
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.
Botox is injected into tissues of the armpit or hand. This may produce approximately six months of relief from sweating. The injections are uncomfortable, but use of a very small 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.
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 compensatory, 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.
Medically reviewed by a Board-Certified Family Practice Physician
Medically Reviewed by a Doctor on 10/9/2014
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