From the Research
For hyperhidrosis, the most effective treatment option is botulinum toxin injections, which provide temporary relief lasting 4-6 months by blocking nerve signals to sweat glands, as supported by the most recent and highest quality study 1. The treatment of hyperhidrosis depends on the severity and location of the condition.
- For primary focal axillary hyperhidrosis, topical aluminum chloride solution is the initial treatment, while botulinum toxin injections are considered first- or second-line treatment 2.
- For palmar and plantar hyperhidrosis, iontophoresis is the primary remedy, and botulinum toxin injections are considered fourth-line treatment 3.
- Oral anticholinergics, such as glycopyrrolate, are useful adjuncts in severe cases of hyperhidrosis when other treatments fail 2. The medications work by either physically blocking sweat ducts (antiperspirants), inhibiting nerve signals that trigger sweating (anticholinergics, Botox), or temporarily disabling sweat glands (iontophoresis), providing options based on the severity and location of hyperhidrosis. Some key points to consider when treating hyperhidrosis include:
- The Hyperhidrosis Disease Severity Scale can be used to grade the tolerability of sweating and its impact on quality of life 2.
- Treatment with botulinum toxin injections was more effective and provided greater patient satisfaction than with aluminum chloride 4.
- Energy-delivering devices, such as lasers and microwave thermolysis, may also be utilized to reduce focal sweating 1.
- Surgery may be considered when more conservative treatments have failed, but it is not recommended for plantar hyperhidrosis due to anatomic risks 3.