Treatment for Hypohidrosis (Difficulty Sweating)
The treatment of hypohidrosis should focus on identifying and addressing the underlying cause while implementing strategies to prevent heat-related complications and improve quality of life. 1
Diagnostic Approach
Before initiating treatment, determine the cause of hypohidrosis:
Exogenous causes:
- Medications (anticholinergics, antidepressants, decongestants)
- Environmental factors
Dermatological causes:
- Congenital disorders affecting ectodermal tissues
- Acquired skin conditions damaging sweat glands
Neurological causes:
- Upper motor neuron disorders (with spasticity, hyperactive reflexes)
- Lower motor neuron disorders (with flaccidity, hypoactive reflexes)
- Autonomic dysfunction
Treatment Algorithm
Step 1: Address Underlying Causes
Medication-induced hypohidrosis:
- Discontinue or modify dosage of offending medications (antidepressants, decongestants, immunosuppressants) 2
- Consider alternative medications with fewer anticholinergic effects
Neurological disorders:
- Treat primary neurological condition
- Consider autonomic testing if cause is unclear
Dermatological conditions:
- Manage primary skin disorders that may affect sweat glands
- Avoid harsh soaps that can damage skin barrier function 3
Step 2: Prevent Heat-Related Complications
Environmental modifications:
- Avoid high temperatures and humidity
- Use air conditioning in hot weather
- Limit exposure to direct sunlight
Hydration strategies:
- Maintain adequate fluid intake before, during, and after physical activity 2
- Drink water before feeling thirsty, especially during exercise
- Consider electrolyte replacement for prolonged activities
Activity modifications:
Step 3: Skin Care Management
Regular bathing:
- Use warm (not hot) water
- Apply fragrance-free, hypoallergenic cleansers 3
Moisturization:
- Apply moisturizers after bathing to maintain skin barrier function
- Use neutral pH products to prevent further skin damage 3
Step 4: Specific Treatments for Refractory Cases
For acquired idiopathic generalized anhidrosis:
- High-dose systemic corticosteroids may be effective 1
For focal hypohidrosis with compensatory hyperhidrosis:
- Treat areas of excessive sweating with topical aluminum chloride or glycopyrrolate 4
Special Considerations
Exercise and Physical Activity
Counter-warming techniques:
- Apply external cooling methods (cool towels, ice packs) during exercise
- Use cooling vests for prolonged outdoor activities
Exercise monitoring:
- Monitor core temperature during exercise when possible
- Exercise in climate-controlled environments when outdoor conditions are extreme 2
Fabry Disease-Related Hypohidrosis
If hypohidrosis is related to Fabry disease:
- Exercise testing with blood pressure monitoring may be indicated 2
- Topical moisturizers can help prevent skin fissures due to hypohidrosis 2
Monitoring and Follow-up
- Regular assessment of heat tolerance
- Evaluation of quality of life impact
- Monitoring for complications such as heat exhaustion or heat stroke
Pitfalls and Caveats
- Hypohidrosis can be life-threatening in extreme heat conditions
- Patients may not recognize reduced sweating as a symptom until complications occur
- Compensatory hyperhidrosis in unaffected areas may mask the diagnosis of focal hypohidrosis
- Patients with hypohidrosis should always carry water and be vigilant about heat exposure
- Avoid alcohol consumption which can precipitate heat stress due to effects on vasomotor tone and volume status 2
By following this structured approach to treating hypohidrosis, clinicians can help patients manage their condition effectively and prevent potentially serious heat-related complications.