Hyperhidrosis (Excess Sweating)
Hyperhidrosis is the condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature.
- Hyperhidrosis can either be generalized or localized to specific parts of the body. Hands, feet, axillae, and the groin area are among the most active regions of perspiration due to the relatively high concentration of sweat glands.
- Primary hyperhidrosis must be distinguished from secondary hyperhidrosis, which can start at any point in life. The latter form may be due to a disorder of the thyroid or pituitary gland, diabetes mellitus, tumors, gout, menopause or certain drugs. Primary hyperhidrosis is estimated at around 1% of the population, afflicting women more.
- The most common treatment is aluminum chloride (hexahydrate) solution. The most common brands are Drysol®, Maxim®, Odaban®, and Driclor®. 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.
- Iontophoresis is often effective in patients with hand or foot hyperhidrosis who do not respond to aluminum chloride. The hand or foot is placed in a device that has two pails of water, each with a conductor. 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 the Drionic®, Idrostar and MD-1A (RA Fischer). There can be some mild pain, which is usually limited to small wounds on the skin. Over time the body adjusts to the procedure.
- Oral medication: There are several drugs available with varying degrees of success. A class of anticholinergic drugs are available that have shown to reduce hyperhidrosis. Ditropan® (generic name: oxybutynin), Robinul® (generic name: glycopyrrolate), propantheline bromide (Probanthine®) and benztropine (Cogentin®). Antidepressant drugs, such as Zoloft®, may also help to alleviate symptoms.
- Botulinum toxin type A (trademarked as 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. The procedure has been approved by the U.S. Food and Drug Administration (FDA), and now some insurance companies pay partially for the treatments.
- Percutaneous Sympathectomy: a minimally invasive procedure in which the sympathectomy nerve is blocked by an injection of phenol.
- Surgery (Endoscopic Thoracic Sympathectomy or ETS): Select sympathetic nerves or nerve ganglia in the chest are either cut, burned or clamped to stop their transmission of impulses. The procedure often causes anhidrosis from the mid-chest upwards, a disturbing condition. Another drawback is compensatory hyperhidrosis (excessive sweating in a new area).