CUSTOM DERMATOLOGY SEARCH:
Treatment Options for Excessive Sweating and Hyperhidrosis
Y. Zhou, MD, PhD, FRCPC (Dermatology)
Excessive production of sweat, or hyperhidrosis, affects millions of people worldwide. Until recently, treatment was difficult. However, new advances have revolutionized the management options for many patients suffering from this condition.
Excessive Sweating vs. Hyperhidrosis
Sweating is a necessary physiological mechanism, and under certain conditions, such as physical exertion or illness, it can become excessive. However, it is not necessarily hyperhidrosis, which is defined as nonphysiological, excessive sweating that is not caused by physical activity and occurs symmetrically in a localized fashion. In either case, it can have a significant negative impact on a patient’s quality of life, including difficulty with work, school, and social relationships. As a result, patients often shy away from situations that require shaking hands or other forms of close physical contact with other people.
Primary Focal Hyperhidrosis (PFHH)
Several forms of treatment are now available for the management of PFHH. The options are slightly different and depend on the condition (excessive sweating vs. hyperhidrosis) and locations involved.
Axillary Excessive Sweating/ HyperhidrosisTopical Antiperspirants
Surgical removal of the sweat glands in the axillae, or ablating the sympathetic chain supplying the sweat glands can also be performed for selected patients. However, unwanted effects of surgical treatment can include:
Consequently, these procedures are reserved for those who do not respond to other treatment options.Oral Anticholinergics
Oral anticholinergics such as glycopyrolate can offer mildto- moderate relief for some patients suffering from PFHH. However, because of the systemic side-effects such as dry mouth, blurred vision, and reduced gastrointestinal motility, systemic anticholinergics have not been the accepted therapy for most patients.
Hyperhidrosis affecting the hands and the feet is also very common, alone or in combination with axillary hyperhidrosis. The treatment options are similar to axillary hyperhidrosis.Topical Antiperspirants
As for excessive sweating and axillary hyperhidrosis, antiperspirants containing aluminium salts in concentrations ranging from 10%–25% are considered the first-line therapies.Botulinum Toxin Subdermal Injections It is highly effective for most patients. Cost of botulinum toxin therapy is significantly higher than for axillary hyperhidrosis because palmoplantar hyperhidrosis requires significantly larger doses.
Tap Water Iontophoresis
As for axillary hyperhidrosis oral anticholinergics, such as glycopyrolate, can offer mild-to-moderate relief for some patients suffering from PFHH. However, because of systemic side-effects, systemic anticholinergics have not been considered as the accepted therapy for most patients.
Endoscopic Trans-Thoracic Sympathectomy
For most patients, antiperspirants containing aluminium salts are the first-line treatments. Other therapeutic options, especially for those with hyperhidrosis, include botulinum toxin injection, systemic anticholinergics, iontophoresis and surgery. Individualized patient counselling and careful attention to adverse effects are the keys to treatment satisfaction.
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Last modified: Thursday, 21-Jun-2012 16:58:57 MDT