Hyperhidrosis (Sweating Excessively) - Health Tips

Q: What are the treatments for hyperhidrosis?

A: The first line treatment consists of using a prescription antiperspirant called Drysol. If this is not effective enough, the use of Botox is now FDA approved for excessive sweating and can safely provide six to eight months of complete cessation of sweating.

Myth: Excessive sweating is just annoying but is not considered a real medical condition.

Truth: Hyperhidrosis is a real and definable medical condition that can have severe negative impacts on patients daily functioning and quality of life and should be treated.

Myth: Hyperhidrosis is a rare disorder.

Truth: Hyperhidrosis affects up to 5% of the worlds population, that is 391 million people!

Myth: Everyone with hyperhidrosis knows they have a medical condition.

Truth: Most people with hyperhidrosis DO NOT realize their excessive sweating is a medical condition, and so they go untreated.

Myth: Excessive sweating is good for your body because it gets rid of ‘toxins’.

Truth: Physiologic sweating is a normal and healthy way for your body to regulate its temperature though evaporation and conductive cooling, however your sweat glands are not involved in the regulation or disposal of any of the bodies waste products.

Myth: Treatment for hyperhidrosis is difficult to do and rarely works.

Truth: While there is currently no cure for primary hyperhidrosis, there are a variety of vary effective and simple treatments.

Myth: Over-the-counter antiperspirant treatments for hyperhidrosis don’t work.

Truth: For mild hyperhidrosis of the axilla the proper use of an OTC antiperspirant can be very effective!

Myth: Long term antiperspirant use can cause cancer in your armpits.

Truth: Extensive studies and decades of safety data do not show an increased risk of cancer with daily use of antiperspirant or deodorant.

As there is no cure for primary hyperhidrosis, management of this condition can be lifelong and involves a combination of medical treatments and behavior modifications to avoid triggers. It is recommended to seek the care of a medical professional, such as a Dermatologist, to treat hyperhidrosis to help guide your management choices.

The most common and potentially effective treatment for mild hyperhidrosis of the armpits is the proper use of an over-the-counter antiperspirant. The most common mistake patients make when they use an antiperspirant is using it during the day. The excessive sweating washes away the salts in the antiperspirant before they can work.

OTC antiperspirants should be applied at night, just before going to bed. As primary hyperhidrosis typically does not occur at night, the medication has time to work and is not washed away by excessive sweating.

Note: do not confuse antiperspirants (anti-sweat) with deodorant (anti-odor). Typically, deodorant will be labeled as both an antiperspirant and deodorant, however, some brands are packaged as only deodorant and do not contain the salts used in antiperspirants.

Unfortunately, over-the-counter antiperspirants are typically not powerful enough to deal with significant hyperhidrosis and are limited only to use in the armpits.

Neuromodulators, such as Botox, although typically used to treat fine lines and wrinkles, have revolutionized the treatment of hyperhidrosis and can be used in a variety of locations, including, the armpits, hands, face, and scalp. By introducing neuromodulators into the affected areas we are able to dramatically reduce, if not stop the excessive sweating for up to nine months to one year with only one treatment.

Other effective treatments include iontophoresis. Iontophoresis is a medical device that can be used at home to reduce sweat production by passing small amounts of electric current through the hands or feet while they are submerged in a thin layer of regular tap water.

Systemic oral medication can also be used to treat hyperhidrosis, typically when multiple locations are involved or they are in areas not amenable to the treatments listed above.

Hyperhidrosis is a personally disturbing condition that can be very disruptive to an individual's day-to-day life. There are several approaches to managing this condition that I take. Suppose the problem is focal such as underarms.  Topical aluminum chloride in 20% concentration applied nightly for 1 to 2 weeks until reduced sweating occurs and then weekly or biweekly after that for maintenance is perhaps the most straightforward option.  This can be done on the palms or soles as well. Qbrexa is a medicated pad containing glycopyrrolate which can be used similarly to aluminum chloride to reduce sweating.  It has anticholinergic effects.  Topicals may be challenging to apply to the hair-bearing areas such as the scalp, may not work well enough, or are intolerable to patients due to side effects of dryness and irritation.  In these cases, I recommend botulinum toxin injection, which works exceptionally well in patients and can last 6 months to 1 year.   In patients with extensive sweating in multiple areas, oral glycopyrrolate is very effective with a low side effect profile.  As always, speak to a board-certified dermatologist to find out what treatment option is best for you.