From the Guidelines
Hyperhidrosis treatment should prioritize minimizing morbidity, mortality, and improving quality of life, with the most effective treatment being botulinum toxin (Botox) injections for severe cases, as they provide 4-6 months of relief by blocking nerve signals to sweat glands, particularly for underarms, palms, and soles 1.
Treatment Options
- For mild cases, start with clinical-strength antiperspirants containing aluminum chloride (like Drysol or Certain Dri), applied to dry skin at bedtime.
- For moderate to severe cases, prescription options include oral anticholinergics like glycopyrrolate (1-2mg twice daily) or oxybutynin (5-10mg daily), which block sweat gland stimulation but may cause dry mouth and blurred vision.
- Iontophoresis, which uses a mild electrical current through water to temporarily block sweat glands, is effective for palms and soles with 20-30 minute sessions several times weekly.
Lifestyle Modifications
- Wearing moisture-wicking fabrics can help keep skin dry and reduce sweating.
- Avoiding spicy foods and caffeine can help reduce sweat gland stimulation.
- Managing stress through relaxation techniques, such as deep breathing or meditation, can help reduce sympathetic nerve activity and subsequent sweating.
Important Considerations
- It's essential to rule out underlying medical conditions that may be contributing to hyperhidrosis, such as hyperthyroidism or diabetes 1.
- Treatment should be individualized based on the severity of symptoms, patient preferences, and potential side effects of treatments 1.
From the Research
Definition and Prevalence of Hyperhidrosis
- Hyperhidrosis is a disorder of excessive sweating beyond what is expected for thermoregulatory needs and environmental conditions 2.
- Primary hyperhidrosis has an estimated prevalence of nearly 3% and is associated with significant medical and psychosocial consequences 2.
Treatment Options for Hyperhidrosis
- Multiple therapies are available for the treatment of hyperhidrosis, including topical medications, iontophoresis, botulinum toxin injections, systemic medications, and surgery 2, 3, 4.
- Topical aluminum chloride solution is the initial treatment in most cases of primary focal hyperhidrosis 3, 4.
- Botulinum toxin injection is considered first- or second-line treatment for axillary, palmar, plantar, or craniofacial hyperhidrosis 2, 3, 5, 6.
- Iontophoresis should be considered for treating hyperhidrosis of the palms and soles 2, 3, 4, 6.
- Oral anticholinergics are useful adjuncts in severe cases of hyperhidrosis when other treatments fail 2, 3, 4.
Treatment Algorithms for Hyperhidrosis
- For axillary and palmoplantar hyperhidrosis, topical treatment is recommended as first-line treatment 2.
- For axillary hyperhidrosis, botulinum toxin injections are recommended as second-line treatment, oral medications as third-line treatment, local surgery as fourth-line treatment, and ETS as fifth-line treatment 2.
- For palmar and plantar hyperhidrosis, a trial of oral medications is considered as second-line therapy, iontophoresis as third-line therapy, botulinum toxin injections as fourth-line treatment, and ETS as a fifth-line option for palmar hyperhidrosis 2.
- For craniofacial hyperhidrosis, oral medications are considered first-line therapy, topical medications or botulinum toxin injections may be useful in some cases, and ETS is an option for severe craniofacial hyperhidrosis 2.
Comparative Evaluation of Treatment Options
- A study comparing botulinum toxin versus iontophoresis with topical aluminium chloride hexahydrate in treatment of palmar hyperhidrosis found that botulinum toxin showed significant improvement in the initial as well as cross over cases as compared to iontophoresis and aluminium chloride 6.
- Another study found that combination therapy with aluminum chloride hexahydrate in a salicylic acid gel base and botulinum toxin type A can greatly improve patient response for moderate to severe hyperhidrosis 5.