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Hyperhidrosis

• Hyperhidrosis, or excessive sweating, is a common disorder.
• Axillary hyperhidrosis is excess sweating of the underarms.
• Palmoplantar hyperhidrosis is excess sweating of the palms and soles.
• Hyperhidrosis usually occurs in people who are otherwise healthy.
• The approach to treating hyperhidrosis generally proceeds from over the counter antiperspirants to prescription antiperspirants, oral medications, Botox, and surgery.

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

What is the cause of hyperhidrosis?

Although neurologic, metabolic and other systemic diseases can sometimes cause excessive sweating. 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 the time, regardless of their mood or the weather.

What is the treatment for hyperhidrosis?

Through a systematic evaluation of causes and triggers of excessive sweating, followed by a sensible, stepwise approach to treatment, many people with this disorder can achieve good results and an improved quality of life.

The approach to treating hyperhidrosis generally proceeds as follows:

• Over-the-counter antiperspirants -- usually tried first because they are readily available. Antiperspirants containing aluminum chloride may be more effective than those without.
• Prescription strength antiperspirants -- those containing aluminum chloride hexahydrate.
• Oral medications -- ones called anticholinergics, which reduce sweating.
• Botox (botulinum toxin) -- recently approved in the US 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, doctors recommend aluminum chloride hexahydrate (Drysol), a prescription-strength version of aluminum chloride. It is applied just before bedtime 7-10 nights in a row, then roughly once a week thereafter to maintain improvement. This treatment works reasonably well for many patients whose problem is excessive underarm sweating, but is not satisfactory for most patients with palm and sole sweating. The main side effect of Drysol is irritation, which can sometimes (but not always) be overcome by reducing the frequency of use, or applying anti-inflammatory medications such as lotions containing hydrocortisone.

Oral Medications

Oral anticholinergic medications are not commonly used for this condition, because in order to work they often produce side-effects like dry mouth and blurred vision. .

Botox

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 niche is the treatment of excessive underarm sweating, and has received FDA approval. Currently, the FDA has not approved Botox for treating sweating of the palms and soles of the feet.

Surgery

Thoracic sympathectomy is 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; the complications can include excessive sweating in other parts of the body and lung and nerve problems. Since many of these complications are serious and not reversible, this option is rarely used, and then only as a last resort.