From the Research
Treatment for hyperhidrosis should start with conservative measures such as aluminum chloride-based antiperspirants for mild cases, and may progress to prescription options like oral anticholinergics, iontophoresis, or botulinum toxin injections for moderate to severe cases, as recommended by the most recent and highest quality study 1.
Overview of Hyperhidrosis Treatment
Hyperhidrosis is a disorder of excessive sweating that can significantly impact a patient's quality of life. The treatment options vary depending on the severity and location of the sweating.
Treatment Options
- For mild cases, start with aluminum chloride-based antiperspirants (like Drysol or Certain Dri) applied nightly to dry skin.
- For moderate to severe cases, prescription options include:
- Oral anticholinergics such as 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 palmar and plantar hyperhidrosis with treatments needed 2-3 times weekly initially, then maintenance sessions.
- Botulinum toxin (Botox) injections provide 4-6 months of relief by blocking nerve signals to sweat glands, particularly for axillary hyperhidrosis.
- For severe cases unresponsive to other treatments, microwave thermolysis (miraDry) permanently destroys sweat glands, or sympathectomy surgery may be considered, though the latter carries risk of compensatory sweating elsewhere, as noted in 2 and 3.
Considerations for Treatment Choice
Treatment choice depends on the affected body area, severity of sweating, and patient preference, with combination approaches often yielding best results, as discussed in 4. It is essential to consider the benefits and risks of each modality and to develop an individualized therapeutic plan, taking into account disease severity, benefit-to-risk profile, treatment cost, patient preference, and clinician expertise.
Recent Recommendations
The most recent study 1 provides a comprehensive review of the treatment options for hyperhidrosis, including lifestyle and behavioral recommendations, antiperspirants, iontophoresis, botulinum toxin injections, oral systemic agents, energy-delivering devices, and surgery. This study recommends a sequenced approach to treatment, starting with conservative measures and progressing to more invasive options as needed.