Managing Hyperhidrosis with a Doctor

Before attempting to self-assess what prescription or treatment will work best for you, finding a qualified dermatologist with specific experience in treating hyperhidrosis is recommended.

Hyperhidrosis is a condition that causes an individual to sweat excessively, even in the absence of environmental triggers like heat. It is an often embarrassing condition that affects an estimated 5% of the world’s population.[1] For some, over-the-counter topical treatments help reduce the excessive sweating caused by hyperhidrosis, while others may need a stronger solution. If you have tried over-the-counter solutions and other methods to manage hyperhidrosis at home and they aren't working, it may be time to talk to your physician about medical treatments. Dermatologists are the best doctors to treat hyperhidrosis. They are able to provide a personalized plan that can address each person’s specific needs.

Find a Qualified Dermatologist with Hyperhidrosis Experience

Before attempting to self-assess what prescription or treatment will work best for you, finding a qualified dermatologist with specific experience in treating hyperhidrosis is recommended. If you find that over-the-counter solutions are not helping alleviate your symptoms, seeking the advice of a trained hyperhidrosis professional may be the next step. A doctor might help you to choose the right over-the-counter antiperspirant or they might decide that you need prescription stregth help.

Prescriptions:

Your dermatologist may provide you with a prescription for a topical cream or an oral medication to treat hyperhidrosis. Depending on your specific situation, you may be prescribed both a topical cream and an anticholinergic pill to alleviate your sweating. Often doctors prescribe anticholinergic medications like glycopyrrolate and oxybutynin to treat excessive sweating, but there are other types of medications for hyperhidrosis that a doctor may prescribe.

Topical Creams:

Commonly, dermatologists will prescribe individuals a topical cream that consists of a sweat-blocking aluminum solution paired with a series of moisturizing elements. These solutions both reduce the amount of sweat your pores produce and ensure the aluminum elements do not irritate your hands, feet, underarms, or other area on the body. Notably, aluminum chloride, aluminum sesquichlorohydrate, and aluminum zirconium are three specific aluminum compounds that are often utilized in these topical solutions to block the pores.[2] When applied to a location where excessive sweating occurs, the aluminum element will enter the pores and then break down into smaller chemical compounds once the solution encounters the water beneath the skin. This process is known as hydrolysis. Since the compound will begin to hydrolyze when it encounters water, keeping the surface of your skin dry and clear of debris is essential to making sure the topical cream reaches the pores. Many dermatologists recommend applying topical creams at night in order to provide the solution ample time to penetrate your dry and clean skin while you sleep. Antiperspirants can be used all over the body and there are some antiperspirants made for places like the face and groin, which are sensitive and prone to irritation. [2]

Anticholinergics:

Whether prescribed alongside topical creams or as an independent solution, your dermatologist may prescribe oral medications for hyperhidrosis known as anticholinergics that stop a signalling chemical known as acetylcholine from delivering messages to certain nerve receptors. Many scientists believe the excess sweating is a result of an individual’s genetic tendency to produce more sweat than necessary. [3] Since an individual’s genes impact how the sweat glands process a notification from the nervous system, blocking cells in the nervous system at the specific binding site that controls sweat production can significantly help reduce sweat. [3] By blocking these receptors, the sweat glands will not receive the synapses from the brain that cause the sweat glands to produce excessive sweat.

An easy way to understand the difference between topical aluminum creams and anticholinergics is to think about your skin as a leaky faucet. One way to stop the faucet would be to put tape over the outside of the faucet so that no water can leak out. Similarly, putting an aluminum cream on the hands blocks the sweat glands and allows less sweat to emerge from the body. A second solution for fixing the leaky faucet would be to decrease the amount of water pressure the faucet receives. Likewise, the anticholinergics decrease the amount of signals the sweat glands receive that instruct them to produce sweat.

Iontophoresis Sessions:

Iontophoresis is a treatment used to treat palmary and plantar hyperhidrosis. It involves delivering a mild electrical current into the problem area of the body and temporarily blocking the sweat glands from producing sweat. [4] During iontophoresis sessions, the affected part of the body is placed in water, and the currents are administered over a 30-minute period. A patient typically conducts sessions weekly or bi-weekly, and it will often take up to 10 sessions before the patient can detect a notable decrease in sweating. [3] Even though it may take a while to show result, iontophoresis really does work. Since the affected part of the body must be submerged in water during iontophoresis, it is most effective when used as a treament for sweaty hands (palmar hyperhidrosis) and as a treatment for sweaty feet (plantar hyperhidrosis). There are ways to make iontophoresis more effective for those who do not recieve satisfactory results.

Surgery:

If your hyperhidrosis symptoms cannot be reduced via topical creams, prescription medicine, or iontophoresis, your dermatologist might recommend a surgical treatment to reduce your sweating. These procedures range from minimally invasive surgeries like as botox injections and local permanent treatments for axillary hyperhidrosis to significantly more invasive procedures like endoscopic thoracic sympathectomies and endoscopic lumbar sympathectomies. [1] Although surgical intervention should only be considered following the failure of less invasive methods, surgery can provide an impressive reduction in excessive sweating in a specific area for the most severe cases of hyperhidrosis.

Botox Injections:

Widely known for its association with cosmetic surgeries, Botox is a substance with a notable potential to treat hyperhidrosis. Botox is used to treat axillary hyperhidrosis frequently, and it has even recieved approval from the FDA for that purpose. Botox is also used to treat palmar and plantar hyperhidrosis. When the botulinum toxin (Botox) is introduced to specific regions containing sweat glands, the neurotransmitters that control the reception of neural messages and the production of sweat are essentially paralyzed by Botox. [5] Since Botox is actually a very strong toxin that can easily paralyze human cells, Botox treatments should be conducted by experienced professionals only. Repeat Botox injections are needed typically every 6 or 12 months to maintain the paralysis of the neurotransmitters. [5]

Endoscopic Thoracic and Lumbar Sympathectomies:

Endoscopic Thoracic (hand) Sympathectomies and Endoscopic Lumbar (foot) Sympathectomies are two procedures that permanently sever the connection between nerves in the spinal cord and sweat glands, stopping the excessive sweating completely in a problem area. Although the surgeries typically stop the sweating in a given area, there are three key risks associated with the ETS and ELS surgeries. First, these surgeries are highly invasive. The patient must be put to sleep via anesthetics for the duration of the surgery, and the surgery is comparatively dangerous to any other hyperhidrosis operation considering that a mistake in the spinal cord could paralyze the patient for life. [6] Second, the surgery can be very expensive. Although costs vary significantly based on personal factors and insurance, paying $5,000-10,000 for an ETS or ELS is not uncommon. Finally, an individual will continue to sweat just as must as they did before the ETS or ELS surgeries. While the sweat will no longer travel to the same location following the ETS or ELS, the body will continue to produce sweat through a process known as compensatory sweating. Since the ETS or ELS only stops the nerves from sending messages to one area and not the body’s sweat production, the sweat that was produced in the hands will be redirected to another spot on the body. [6] A surgical treatment for primary focal hyperhidrois is irreversible, and should only be considered if your symptoms are severe and no other treatment options has help reduce your sweat. [6]

There are many potential treatment options for those with hyperhidrosis, but what about children? There are medical treatments for children with hyperhidrosis available, although they are more limited than those available to adults. The medical cost of hyperhidrosis can be high, but it is important for those with the condition to seek out treatment if they feel it is impacting their lives. Hyperhidrosis can have a negative impact on a person's quality of life, so medical treatment should be thought of as an important step for those who are struggling to manage their sweat.

Sources
  1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Amsterdam: Elsevier Pub. Co., 2014. Retrieved
  2. Kamudoni, P., Mueller, B., Halford, J., Schouveller, A., Stacey, B., & Salek, M. (2017, June 8). The impact of hyperhidrosis on patients' daily life and quality of life: A qualitative investigation. Retrieved May 21, 2018, from https://hqlo.biomedcentral.com/articles/10.1186/s12955-017-0693-x
  3. Symposium on Anticholinergic Drug and Brain Functions in Animals,and Man. (1968). In Bradley P. B. (Ed.), Anticholinergic drugs and brain functions in animals and man Amsterdam, New York etc.] Elsevier Pub. Co., 1968. Retrieved
  4. Scifers, James R, DScPT, PT, SCS,L.A.T., A.T.C., Lewandowski, Jeff, DPT, PT, SCS,A.T.C., M.T.C., O'Brien, Matthew, PhD, LAT, ATC, & Watts, Jay, RPh,F.A.C.A., F.A.C.V.P. (2013). Iontophoresis. Athletic Training & Sports Health Care, 5(3), 103-105. doi:http://dx.doi.org.proxy.lib.duke.edu/10.3928/19425864-20130509-03
  5. Melissa A. Doft, MD;, Jeffrey A. Ascherman, MD, & Krista L. Hardy, BS. (2011, July 8). Treatment of Hyperhidrosis With Botulinum Toxin. Retrieved May 21, 2018, from goo.gl/8vfXVA
  6. Mancini, M., Zieve, D., & Conaway, B. (2017, January 31). Endoscopic Thoracic Sympathectomy. Retrieved May 21, 2018, from https://medlineplus.gov/ency/article/007291.htm
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