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Options to treat excessive sweating (hyperhidrosis)

Hi Everyone:

Excessive sweating is known as hyperhidrosis. Sometimes it’s very severe, sometimes it is just perceived as severe…but either way, it’s a problem. There is no known cure for hyperhidrosis unless it’s due to an underlying illness such as hyperthyroidism or other illnesses. Despite this, there are several treatment options that can lead to successful outcomes. Below I discuss these treatments in order of aggressiveness.

For axillary (armpit) hyperhidrosis, I would recommend starting with over-the-counter (OTC) clinical strength antiperspirants. They provide some help over regular strength antiperspirants by creating a small plug to decrease the outward flow of sweat onto the skin. Brands include Arrid, Degree, Dove, Certain-Dri, Gilette, Hydrosal, PerspireX, Secret and Sure.

Treatment with a topical solution containing aluminum chloride should be your first step in treating sweating of the palms, feet, scalp and your next step in combating axillary hyperhidrosis. Like clinical strength antiperspirants, these solutions also create a plug that decreases sweat outflow. The strength of the aluminum chloride solution ranges from 10% to approximately 50%. It is sometimes used in combination with salicylic acid in a gel form. For underarm sweating, I recommend the lower concentrations of 10-15% due to the potentially irritating nature of this treatment (armpit skin is very sensitive), and higher concentrations for excessive sweating of the hands and feet. These should be applied at night to completely dry skin. I recommend blow-drying the area on the warm (not hot) setting before application. Extreme caution must be used with increasing strength. After it’s applied, I recommend blow-drying the applied area again but on a cool setting, so that the alcohol in the solution evaporates. I also recommend wearing a t-shirt if you are applying it to your underarms, and if you are using it on your hands or feet, use cling wrap over the applied area under mittens or socks. This will increase the efficacy of the treatment and also avoid the solution getting on your sheets. Wear a shower cap if you’ve applied it to your scalp. Do not apply to irritated or abraded skin or after shaving. Once you’ve done this for several nights in a row, weekly use is recommend to maintain the effects of the treatment. If irritation develops, discontinue use of products with the solution until the irritated area has totally recovered. Drysol, Hypercare and Xerac AC are common OTC brands that you could try.

Iontophoresis is an effective treatment for excessive sweating that requires a doctor-prescribed machine. The machine passes a safe mild electric current into the skin. It does not hurt but can tingle or sting. However, it is a bit annoying to use. To start out with, it takes about ten daily 20-40 minute sessions. Weekly maintenance treatments every 2-3 days are needed to sustain the effect. Iontophoresis is typically recommended for the hands and feet. It’s more difficult to use for the armpits and irritation is more common when used there. Drionics and Fischer are two machine brands that could be purchased.

Besides being used for wrinkles, headaches, muscle spasms and many other medical conditions, Botox, which requires a visit to the doctor, can be used as a highly effective treatment for hyperhidrosis. The best areas on which to use Botox are the armpits and scalp. Injecting it in these areas doesn’t really hurt. It can also be used for hands and feet. The down side of using it for the hands and feet is that it hurts to inject it in these areas so sometimes a “nerve block” to numb the area is used which leaves you numb for several hours. It is also possible that when Botox is used in the hands it can cause some temporary weakness of the hand muscles. So it may not be ideal for anyone who relies on fine motor skills such as nurses. This effect is not seen in the armpits and scalp. The biggest downside of Botox is the cost, which can run into the hundreds or even thousands of dollars if it is not covered by insurance. Allergan, the manufacturer of Botox, has recently instituted a program where the cost of the Botox is free for your first hyperhidrosis! This does not cover the cost of the injection but that is often covered by insurance. So if you are interested in trying Botox for hyperhidrosis, now is the time!!!!

Anticholinergics such as robinul (glycopyrrolate) are another effective treatment for excessive sweating. This treatment can actually be a life changer for some. I mention it after the above treatments only because it’s an oral pill and therefore has potential systemic side effects. In the U.S. you have to get a prescription from your dermatologist. The great thing is that because it’s a pill it’s easy to use and it will treat hyperhidrosis anywhere you have it. So, if you have excessive sweating in your hands and feet, for instance, it will treat both areas! Because it’s not target specific, however, it can actually dry you out everywhere, so side effects such as dry mouth and eyes are common. But, in my experience, most patients find this a minor inconvenience and are usually willing to put up with these side effects. It is by no means is a cure and you will still sweat, just not as much. Because the effects don’t last all day for some, you may have to take it more than once a day. The dose typically ranges anywhere from 1-2 mg 1-3 times a day and you usually have to titrate the dose and frequency to what works best for you.

Finally, there’s surgery. However, I must stress this is a last option and the outcome is not always a good one. There are two options for surgery. The first, axillary resection, is used for excessive sweating in the armpits and can cause scarring or decrease arm mobility. Lastly, endoscopic sympathectomy is a surgical procedure where a sympathetic chain is cut or disrupted resulting in decreased sweating. Although it can be highly effective it often results in compensatory sweating which means sweating somewhere else usually on the trunk, buttocks or thighs significantly increases. I have seen this side effect on many occasions and it can be devastating to patients so I highly discourage this procedure.