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: 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 that 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. 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 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 to 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 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.
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.
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. 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.
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