From the Guidelines
Treatment for hyperhidrosis should prioritize non-surgical approaches, starting with clinical-strength antiperspirants and oral medications, due to the limited evidence on surgical options and potential side effects. When considering treatment options for hyperhidrosis, it's essential to evaluate the severity of the condition and its impact on the patient's quality of life.
- Non-surgical approaches include:
- Clinical-strength antiperspirants containing aluminum chloride
- Oral medications such as anticholinergics like glycopyrrolate or oxybutynin
- Iontophoresis, which uses a mild electrical current through water to temporarily block sweat glands
- Botulinum toxin (Botox) injections for focal hyperhidrosis
- Surgical options, such as endoscopic thoracic sympathectomy (ETS), are typically reserved for severe cases unresponsive to other treatments, but carry risks of compensatory sweating elsewhere 1. In cases with severe thermodysregulation, oral retinoids can be tried, as they have shown a positive effect in reducing hyperkeratotic plugging of sweat glands 1. It's crucial to note that the effects of local and systemic therapy on hyperhidrosis are not well known, and patients should be advised to avoid extreme temperatures and outdoor activities during the hottest periods of the day, wear adequate clothing, and use cooling devices to help manage their condition 1.
From the Research
Treatment Options for Hyperhidrosis
The treatment options for hyperhidrosis (excessive sweating) include:
- Topical treatments such as aluminum chloride, which should always be first-line therapy 2, 3, 4, 5
- Iontophoresis, typically recommended for those with palmar or plantar hyperhidrosis 2, 3, 4
- Botulinum toxin injections, considered first- or second-line therapy in severe axillary hyperhidrosis 2, 3, 4, 6
- Oral medications such as anticholinergics, considered after failure of all other nonsurgical treatments 2, 3, 5
- Local microwave therapy, a newer treatment option for axillary hyperhidrosis 3
- Energy-delivering devices such as lasers, ultrasound technology, microwave thermolysis, and fractional microneedle radiofrequency 4, 5
- Surgery, considered in severe cases of hyperhidrosis that have not responded to topical or medical therapies 3, 4
Specific Treatment Options for Different Types of Hyperhidrosis
- For palmar and plantar hyperhidrosis, iontophoresis is the primary remedy 3, 4
- For axillary hyperhidrosis, botulinum toxin injections are considered first- or second-line therapy 2, 3
- For craniofacial sweating, topical glycopyrrolate is first-line treatment, and botulinum toxin injections are also considered 3
- For generalized hyperhidrosis, oral systemic agents may be reserved for treatment-resistant cases 4