From the Research
Hyperhidrosis associated with PTSD should be managed with a multi-faceted approach, prioritizing antiperspirants containing aluminum chloride as first-line treatment, alongside trauma-focused psychotherapy and medications like SSRIs for PTSD management, as supported by the most recent and highest quality study 1.
Treatment Approach
When managing hyperhidrosis related to PTSD, it's essential to address both the excessive sweating and the underlying PTSD. The treatment approach should include:
- First-line treatments: antiperspirants containing aluminum chloride (such as Drysol or Certain Dri), applied nightly to affected areas until improvement, then reduced to 1-2 times weekly for maintenance
- Oral medications: glycopyrrolate (1-2mg twice daily) or oxybutynin (5-10mg daily) to block acetylcholine receptors that stimulate sweat glands
- PTSD management: trauma-focused psychotherapy (like Cognitive Processing Therapy or EMDR) combined with medications such as SSRIs (sertraline 50-200mg daily or paroxetine 20-60mg daily) to reduce overall autonomic hyperarousal
- Additional relief: lifestyle modifications, including wearing breathable fabrics, avoiding spicy foods and caffeine, and practicing relaxation techniques like deep breathing or progressive muscle relaxation
Rationale
The rationale behind this approach is to address the excessive sweating directly, while also managing the underlying PTSD that may be triggering or worsening the hyperhidrosis. By using a combination of topical treatments, oral medications, and psychotherapy, patients can experience significant improvement in their symptoms and quality of life, as suggested by 2 and 1.
Key Considerations
When implementing this treatment approach, it's essential to consider the following:
- Patient education: educate patients on the importance of consistent treatment and lifestyle modifications to manage hyperhidrosis and PTSD
- Monitoring: regularly monitor patients for improvement in symptoms and adjust treatment as needed
- Referral: consider referral to a specialist for botulinum toxin A, iontophoresis, or sympathectomy for severe cases of hyperhidrosis, as recommended by 3 and 4