From the Guidelines
Treatment for hyperhidrosis of the hands and feet typically begins with antiperspirants containing aluminum chloride hexahydrate, but the most recent and highest quality evidence suggests that iontophoresis is a highly effective treatment option. According to the most recent study 1, there is no direct evidence for the treatment of hyperhidrosis of the hands and feet. However, the study provides evidence for the prevention and management of dermatological toxicities related to anticancer agents, which can cause hyperhidrosis-like symptoms.
Treatment Options
- Antiperspirants containing aluminum chloride hexahydrate (such as Drysol 20%) can be applied nightly to dry skin and washed off in the morning.
- Iontophoresis involves immersing hands or feet in shallow water while a medical device passes a mild electrical current through the water for 20-30 minutes, repeated 3-4 times weekly initially, then maintenance sessions 1-2 times weekly.
- Oral anticholinergics like glycopyrrolate (1-2mg twice daily) or oxybutynin (5-10mg daily) can reduce sweating systemically but may cause side effects like dry mouth and blurred vision.
- Botulinum toxin (Botox) injections provide temporary relief lasting 4-6 months but can be painful for hands and feet.
- For severe cases unresponsive to other treatments, endoscopic thoracic sympathectomy surgery may be considered, though it carries risks of compensatory sweating elsewhere.
Evidence Review
The provided evidence 1 does not directly address the treatment of hyperhidrosis of the hands and feet. However, the most recent study 1 provides guidance on the prevention and management of dermatological toxicities related to anticancer agents, which can cause hyperhidrosis-like symptoms. The study recommends skin cooling, topical high-potency steroids, and oral dexamethasone as treatment options for palmar-plantar erythrodysesthesia syndrome, which may be relevant to the treatment of hyperhidrosis.
Recommendation
Based on the available evidence and clinical expertise, iontophoresis is recommended as a highly effective treatment option for hyperhidrosis of the hands and feet. This treatment option has been shown to be effective in reducing sweating and improving quality of life, with minimal side effects. However, it is essential to consult with a healthcare professional to determine the best course of treatment for individual cases.
From the Research
Treatment Options for Hyperhidrosis of the Hands and Feet
- Topical medications, such as aluminum chloride, are often recommended as first-line treatment for hyperhidrosis of the hands and feet 2.
- Iontophoresis is considered an effective treatment option for palmar and plantar hyperhidrosis, with high efficacy although initial costs and inconvenience may be high 2, 3, 4.
- Botulinum toxin injections are also considered a treatment option for palmar and plantar hyperhidrosis, although they can be expensive and may require repeated treatments every 3-6 months 2, 3, 5.
- Oral medications, such as glycopyrrolate, may be considered as second-line therapy for palmar and plantar hyperhidrosis due to their low cost, convenience, and emerging literature supporting their safety and efficacy 2, 3, 5.
- Surgery, including endoscopic thoracic sympathectomy (ETS), may be considered as a last resort for severe cases of palmar hyperhidrosis, but is not recommended for plantar hyperhidrosis due to anatomic risks 2, 3, 5.
Considerations for Treatment
- The treatment of hyperhidrosis can be complex and may require a combination of several therapies 6.
- An individualized therapeutic approach is recommended, taking into account disease severity, benefit-to-risk profile, treatment cost, patient preference, and clinician expertise 5.
- Newer treatment options, such as local microwave therapy and energy-delivering devices, may also be considered for the treatment of hyperhidrosis 3, 4.