What is the treatment for hyperhidrosis?

Hyperhidrosis At A Glance

• 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.

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.

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.

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