Hyperhidrosis

What Is Hyperhidrosis?

Hyperhidrosis, or excessive sweating, is a common disorder which produces a lot of unhappiness. An estimated 2%-3% of Americans suffer from excessive sweating of the underarms (axillary hyperhidrosis) or of the palms and soles of the feet (palmoplantar hyperhidrosis). Underarm problems tend to start in late adolescence, while palm and sole sweating often begins earlier, around age 13 (on the average). Untreated, these problems may continue throughout life.

Sweating is embarrassing, it stains clothes, ruins romance, and complicates business and social interactions. Severe cases can have serious practical consequences as well, making it hard for people who suffer from it to hold a pen, grip a car steering wheel, or shake hands.

What Causes Hyperhidrosis?

Although neurologic, endocrine, infectious, and other systemic diseases can sometimes cause hyperhidrosis, most cases occur in people who are otherwise healthy. Heat and emotions may trigger hyperhidrosis in some, but many who suffer from hyperhidrosis sweat nearly all their waking hours, regardless of their mood or the weather.

What is the Treatment for Hyperhidrosis?

Here are various options:

Over-the-counter antiperspirants containing a low dose of metal salt (usually aluminum) are usually tried first because they are readily available. Antiperspirants containing aluminum chloride (for example Certain Dri) may be more effective when other antiperspirants have failed.

Prescription strength antiperspirants, such as Drysol, which contain aluminum chloride hexahydrate.  These work by “plugging up” the ducts that emit sweat, so they work only as long as you use them regularly.  Otherwise the channels open up and sweat begins again. They are often very irritating, especially to the surrounding skin.  Sometimes using barrier creams around the armpit can help prevent the spread of the Drysol to normal skin, but often a mild topical cortisone cream is needed to treat the irritated skin.

Iontophoresis

Iontophoresis has been used to treat excessive sweating on the hands and feet since the 1940s. Iontophoresis is sometimes recommended for people who’ve tried prescription or clinical strength antiperspirants, but need a stronger treatment and don’t want to try botulinum toxin injections.   For people with hyperhidrosis of the hands and/or feet, iontophoresis treatments has been shown to dramatically decrease sweating. One study found that iontophoresis helped 91% of patients with excessive palmoplantar (hands and feet) sweating. Another study showed that iontophoresis reduced palmoplantar sweating by 81%.  However, it’s a cumbersome device and obviously, difficult to travel with.

During iontophoresis, a medical device is used to pass a mild electrical current through water (usually using shallow pans for hands or feet or specific pads for other body areas) and through the skin’s surface. There are no significant or serious side effects and the benefits are long-term, provided you keep up with the maintenance schedule your doctor recommends (usually once per week). These treatments cannot be used by patients with pacemakers.  

Topical preparations:

Qbrexza (glycopyrronium)is a new, FDA-approved prescription topical medication, applied daily to each underarm as a wipe.  It is a topical form of the oral anti-cholinergic medication Robinul (which is rarely used today), and can possibly cause some of the same side effects that the oral medication causes, including blurred vision,  dry mouth, and urinary retention.

Botox and Excessive Sweating

Botulinum toxin A (Botox, Xeomin and Dysport), a nerve toxin that can temporarily paralyze muscle, is often in the news as a cosmetic treatment for wrinkles. But it 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.

It has been approved by the FDA for this purpose and has literally been a life-changing treatment for many people.  The injections are essentially painless, and the results typically last for 6 months to a year. Hyperhidrosis of the palms, another common condition, is also readily treated this way, and is almost a miracle solution to the problem.  Again, a life-changer for many people!

While some insurance companies will cover the procedure, it varies by provider.  Yes, it is somewhat costly if not covered, but so is dry cleaning and replacing clothing which has been damaged by sweat stains!

miraDry

miraDry is a noninvasive treatment using electromagnetic energy treatment that was FDA approved in 2011 for the treatment of excessive underarm sweating. It targets heat on sweat glands, destroying them. Local anesthesia is used and the skin is cooled during this hour-long procedure. Since it’s difficult to target exactly where the sweat glands are, many people have to undergo at least two treatments to see lasting results.  This treatment is performed in a physician’s office, and, while effective, can cause persistent swelling and discomfort in some patients, and occasionally has caused permanent nerve damage to the armpits.  For this reason, it has not become a popular option.

With all of these available treatments, hyperhidrosis is no longer something to be left unattended if it affects your life negatively.  Talk to your physician and take action!