Treatment for Hyperhidrosis

Surveys have also found that few people with hyperhidrosis seek medical treatment for their debilitating sweating, perhaps because they mistakenly believe that no doctor or treatment can help them.

But effective treatments do exist for hyperhidrosis. The condition can be successfully managed, resulting in dramatic improvements to a person’s quality of life.

Topical Treatments

Mild focal hyperhidrosis is often first treated with topical medications. Your doctor may recommend an over-the-counter antiperspirant containing aluminum salts. A prescription antiperspirant containing 25 percent aluminum chloride may also be recommended. These prescription medications have been shown to reduce mild axillary hyperhidrosis in as many as 98 percent of cases. They can also be effective for mild palmar (hand) and plantar (foot) hyperhidrosis.

Oral Medications

Some cases of hyperhidrosis respond well to oral anticholinergic medications. These drugs block the actions of acetylcholine, a neurotransmitter that plays a role in stimulating sweat glands. Sedatives and anti-depressant medications are sometimes prescribed in conjunction with anticholinergics. Side effects for anticholinergic medications include dry mouth and eyes, blurry vision, and constipation.

Iontophoresis

This treatment uses a device to introduce ions onto the skin through a low-level (battery-induced) electrical current. During the procedure, you will be asked to place your hand or foot in a shallow basin of water as the current is passed through it. (The procedure is primarily used for palmar and plantar hyperhidrosis because those parts of the body can be most easily submerged in water.)

No large randomized studies have been conducted on iontophoresis, but other research suggests the treatment is 80 to 100 percent effective in achieving normal sweating after 6 to 10 sessions. The results are not permanent, however, and the treatment sessions are time-consuming, requiring 30 to 40 minutes for each hand or foot.

BOTOX

Botulinum toxin A, the neurotoxin produced by the bacteria that causes botulism, is the best-studied treatment for focal hyperhidrosis. It is injected into the area being treated, where it blocks the nerves that stimulate sweating. Patient satisfaction with this treatment is high (almost 100 percent in clinical trials). The treatment must be repeated, however, for its effects on the sweat glands are temporary, typically lasting only 4 to 7 months.

Surgical Treatments

Surgery is usually considered only when all other treatments have failed. Such procedures include endoscopic thoracic sympathectomy (ETS), which involves clipping, cauterizing, or otherwise destroyed the nerves that transport messages from the sympathetic nerves to the sweat glands. ETS has been shown to be effective in eliminating underarm, hand, and facial hyperhidrosis in 68 to 100 percent of cases. It’s less effective—and often not recommended—for foot hyperhidrosis.

Another surgical procedure sometimes used for underarm (axillary) hyperhidrosis is tumescent liposuction, which removes the troublesome sweat glands. The cuts are small, but they can result in permanent scarring that may limit shoulder movement.

All surgical options for hyperhidrosis are permanent, but they carry the risk of unwanted side effects. The most notable of these risks is mild to severe compensatory sweating, or an increase of sweating on other areas of the body. Up to 86 of individuals who undergo surgery for hyperhidrosis experience compensatory sweating, which in some cases can be just as debilitating as the original.