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What treatments are available for hyperhidrosis?

 

Antiperspirants

 

Often considered the first line of treatment, antiperspirants are a non-invasive response to excessive sweating that is relatively inexpensive. When applied to the top of the skin, antiperspirants seep below the skin’s surface and form temporary plugs to the sweat duct. They can be prescribed or bought over the counter, making them an easy option when initially combatting hyperhidrosis. If used at too high a strength, the antiperspirant may cause skin irritation, so it is crucial to begin with a gentle formula and only increase the strength if you experience no irritation and it is ineffective at combating excessive sweating.

 

Prescription Cloth Wipes

 

Excessive sweating can be combated through the use of cloths that use glyprronium tosylate to limit underarm sweating. This is usually used once a day by wiping the cloth under each armpit.  Due to the strength of the cloth, irritation may be caused to the skin, including burning, stinging, and redness.

 

Iontophoresis

 

Iontophoresis involves an electrical current travelling through water that the target area of the body is submerged in, usually limited to the hands and feet. This treatment can last between 15 and 40 minutes and enables long term relief from hyperhidrosis. While there are no severe side effects to iontophoresis, it does not apply to those whose hyperhidrosis goes beyond their hands and feet. It may also be limited by the location of the procedure, as ‘soft’ water is less effective (as it contains fewer minerals and electrolytes).

 

Botulinum Toxin

 

Botox can be used to block the sweat glands to stop underarm sweating. It acts as a temporary solution (lasting between 2 and 6 months) that can be repeated if it produces the desired effect.

Before the treatment, a consultation will establish whether you have any health conditions that the botox can interfere with. It will begin with sanitisation and (depending on the injection site) the application of an anaesthetic. You will then receive the botox, a process that takes between 15 and 45 minutes, depending on the area. The patient is awake during the process.

There is a risk of muscle weakness, flu-like symptoms, and sweating in other parts of the body following botox, but this should wear off after a few days. Besides these minor side effects, it is rare to suffer further complications.

 

Endoscopic Thoracic Sympathectomy (ETS)

 

ETS is used for severe hyperhidrosis when the body is not responding to alternative treatments. It is a minimally invasive surgery that can target a range of body areas (including the armpits, hands and face). It works by interrupting the transmission of nerve signals to stop the sweat gland from working. Before beginning surgery, the patient will be given general anaesthesia. It is a keyhole procedure, using a miniature camera to magnify the target area. During the surgery, one lung is temporarily collapsed.

One benefit of ETS surgery is that, due to its keyhole nature, the surgery has a fast recovery time (usually around one hour) and can return to normal activities promptly.

ETS surgery should only be considered when all other options have been exhausted due to the potential risks and side effects. When the lung is reinflated, air may be left in the chest cavity (pneumothorax) but should be reabsorbed. Bleeding in the chest (hemothorax) is another potential risk of the surgery. Additionally, side effects can include compensatory sweating, Horner’s Syndrome, neuritis, decreased heart rate, and dry facial skin, amongst other conditions.

 

Sweat Gland Removal Surgery

 

Another option for severe hyperhidrosis is surgically removing the sweat glands. This can be achieved through excision, liposuction, curettage, or laser surgery. The area that is being treated will be numbed, but the patient will remain awake. This is a permanent solution but may result in scarring or compensatory sweating elsewhere on the body after having the targeted sweat glands removed.

How do I know which treatment is right for me?

 

Patients should be encouraged to begin treatment of excessive sweating with antiperspirants. It is essential to assess whether the treatment you are undergoing is satisfactory regularly, and then you may consider the next step. At each point, consulting with your doctor will help you to establish the best course of action moving forward.

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