Hyperhidrosis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]
Overview
Hyperhidrosis can usually be very effectively controlled, but there is no known permanent cure because little is known about the cause behind excessive sweating.
Medical Therapy
Medications
- Antiperspirants (Drysol) can be applied to the hands and armpits at night and then removed in the morning. These are usually tried first and may be effective in mild cases.
- Aluminum chloride (hexahydrate) solution: Common brands of aluminum chloride solution (as antiperspirant) include, MegaDry® (which uses a non-irritating blend of aluminum chlorohydrate), B+Drier®, Odaban®, Sweat-Stop forte® and Driclor®. While aluminum chloride is used in regularantiperspirants, hyperhidrosis sufferers need a much higher concentration to effectively treat the symptoms of the condition. A 15% aluminum chloride solution or higher usually takes about a week of nightly use to stop the sweating, with one or two nightly applications per week to maintain the results. An aluminum chloride solution can be very effective; some people, however, cannot tolerate the irritation that it can cause but these constitute a minority of all patients. Also, the solution is usually not effective for palmar (hand) and plantar (foot) hyperhidrosis - for which iontophoresis (see below) may yield better results in some circumstances.
- Botulinum toxin type A (Botox®): Injections of the botulinum toxin are used to disable the sweat glands. The effects can last from 4-9 months depending on the site of injections. With proper anesthesia the hand and foot injections are almost painless. The procedure when used for underarm sweating has been approved by the U.S. Food and Drug Administration (FDA), and now some insurance companies pay partially for the treatments.
- Oral medication: There are several oral drugs available to treat the condition with varying degrees of success.
- A class of anticholinergic drugs are available that have shown to reduce hyperhidrosis. Ditropan® (generic name: oxybutynin) is one that has been the most promising. For some people, however, the drowsiness and dry-mouth associated with the drug cannot be tolerated. A time release version of the drug is also available, called Ditropan XL®, with purportedly reduced effectiveness. Robinul® (generic name: glycopyrrolate) is another drug used on an off-label basis. The drug seems to be almost as effective as oxybutynin, with similar side-effects such as a dry mouth or dry throat often leading to pain in these areas. Other less effective anticholinergic agents that have been tried include propantheline bromide (Probanthine®) and benztropine (Cogentin®).
- A different class of drugs known as beta-blockers has also been tried, but does not seem to be nearly as effective.
- Since the disorder is often caused by or exacerbated by high-anxiety, antidepressant drugs can help alleviate symptoms.
Non Medicinal
- Iontophoresis: This method was originally described in the 1950s, and its exact mode of action remains elusive to date. The affected area is placed in a device that has two pails of water with a conductor in each one. The hand or foot acts like a conductor between the positively- and negatively-charged pails. As the low current passes through the area, the minerals in the water clog the sweat glands, limiting the amount of sweat released. Common brands of tap water iontophoresis devices are theDrionic®, Idrostar and MD-1A (RA Fischer). Some people have seen great results while others see no effect. However, since the device can be painful to some (it is important to note that pain is usually limited to small wounds and that over time the body adjusts to the procedure) and a great deal of time is required, no cessation of sweating in some people may be the result of not using the device as required. The device is usually used for the hands and feet, but there has been a device created for the axillae (armpit) area and for the stump region of amputees.
- Weight loss: Hyperhidrosis can be aggravated by obesity, so weight-loss can help. However, most people with hyperhidrosis do not sweat excessively due to obesity.
- Relaxation and meditation: Relaxation techniques have been tried with limited success.
- Hypnosis: Hypnosis has been used with limited success.
- Talc/Baby Powder: One temporary treatment is talc or baby powder because the powder will absorb the sweat; however, after a while the powder may become a messy white coating on the place of application.
- Acupuncture
Natural Remedies
- Sage Herb: Sage Herb has also traditionally been used to treat excessive sweating in Germany as well as for night sweats caused by menopause or tuberculosis.[3] It can be taken as a tea or in capsule form daily and can reduce sweating by 50% or more. The herb sage has also been found to boost memory [4] and has many other benefits.