What are the treatment options for secondary hyperhidrosis?

Treatment Options for Secondary Hyperhidrosis

For secondary hyperhidrosis, treatment should focus on addressing the underlying medical condition while using targeted therapies to manage excessive sweating symptoms.

Understanding Secondary Hyperhidrosis

Secondary hyperhidrosis differs from primary hyperhidrosis in that it is caused by an underlying medical condition or medication use, rather than being idiopathic. It may be focal or generalized, and typically requires a different treatment approach than primary hyperhidrosis 1.

First-Line Treatment Options

1. Address the Underlying Cause

• Identify and treat the underlying medical condition causing the hyperhidrosis
• Review medications that may be contributing to excessive sweating
• Consider medication adjustments if pharmaceutically-induced

2. Topical Treatments

• Aluminum chloride (15% solution) is recommended as first-line topical treatment for focal secondary hyperhidrosis, particularly for axillary involvement 2
• Apply to completely dry skin before bedtime and wash off in the morning
• Common mistake: Inadequate drying before application reduces effectiveness 2

3. Topical Anticholinergics

• Topical glycopyrrolate is preferred for craniofacial hyperhidrosis 2
• Apply as directed to affected areas

Second-Line Treatment Options

1. Iontophoresis

• Recommended for palmar and plantar hyperhidrosis 2
• Treatment protocol: 20-30 minute sessions, 3-4 times weekly initially, then 1-2 times weekly for maintenance
• Delivers low-level electrical current through water to temporarily block sweat glands

2. Botulinum Toxin Injections

• Effective for focal secondary hyperhidrosis, particularly axillary, palmar, and plantar areas 2, 3
• Duration of effect: 3-9 months, requiring repeated treatments
• Note: Injections for palmar hyperhidrosis can be painful 2

3. Systemic Anticholinergics

• Glycopyrrolate (1-2 mg once or twice daily) can be used when topical treatments fail 2
• Oxybutynin is an alternative but has significant side effects including dry mouth, constipation, blurred vision, and cognitive effects 2
• Clonidine (0.1 mg twice daily) is another systemic option 2

Surgical Options (For Refractory Cases)

1. Local Procedures

• Curettage or liposuction for axillary hyperhidrosis 2
• Removes or destroys sweat glands in the affected area

2. Endoscopic Thoracic Sympathectomy (ETS)

• Last resort for severe, treatment-resistant cases 2
• Caution: Can result in compensatory hyperhidrosis, which may be worse than the original condition 4

Newer Treatment Options

1. Microwave Therapy

• Specifically for axillary hyperhidrosis 2
• Non-invasive option that destroys sweat glands

Lifestyle Management

• Avoid extreme temperatures and outdoor activities during hot periods 2
• Use cooling devices in hot environments
• Wear moisture-wicking clothing
• Apply cold water or packs regularly to cool the skin

Treatment Monitoring

• Use the Hyperhidrosis Disease Severity Scale (HDSS) to assess treatment effectiveness 2
• Treatment is considered successful when HDSS score is reduced to <2
• Regular follow-up to adjust treatment as needed

Important Considerations and Cautions

• Anticholinergics are contraindicated in patients with glaucoma, myasthenia gravis, and significant bladder outflow obstruction 2
• In hot environments, patients using anticholinergics are at risk for heat prostration due to decreased sweating 5
• Patients using glycopyrrolate should take it at least one hour before or two hours after meals for optimal absorption 5

Remember that while treating the symptoms of secondary hyperhidrosis is important for quality of life, identifying and addressing the underlying cause is essential for long-term management and preventing potential complications.