What is the treatment for hyperhidrosis under the breast?

Management of Hyperhidrosis Under the Breast

Topical aluminum chloride (15% solution) is the first-line treatment for hyperhidrosis under the breast, with a 72% response rate in moderate-to-severe cases. 1

Initial Assessment and Conservative Measures

• Evaluate the severity using the Hyperhidrosis Disease Severity Scale (HDSS)
• Identify potential exacerbating factors:
  • Obesity (weight reduction may improve symptoms) 2
  • Tight clothing causing friction 2
  • Hot environments 2

First-Line Conservative Approaches

1. Moisture management:

   • Wear moisture-wicking cotton clothing 1
   • Avoid tight clothing that increases friction 2
   • Use absorbent powders to keep the area dry
   • Regular cleansing with antiseptic washes to prevent secondary infections 2

2. Environmental modifications:

   • Avoid extreme temperatures and outdoor activities during hot periods 2, 1
   • Use cooling devices (fans, air conditioning) in hot environments 2
   • Apply cold water or packs regularly to help cool the skin 2, 1

Medical Treatment Algorithm

Step 1: Topical Treatments

• Aluminum chloride (15-20% solution) applied nightly to completely dry skin 1, 3
  • Apply to completely dry skin before bedtime
  • Wash off in the morning
  • Once control is achieved, reduce to 1-2 applications weekly
  • Common side effect: skin irritation

Step 2: Anticholinergic Preparations

If aluminum chloride is ineffective or poorly tolerated:

• Topical glycopyrrolate solution or wipes 1, 4
  • Apply once or twice daily to affected areas
  • Less irritating than aluminum chloride

Step 3: Botulinum Toxin Injections

For persistent cases not responding to topical treatments:

• Botulinum toxin A injections 1, 5, 3
  • Highly effective with 3-9 months duration of effect
  • Requires multiple small intradermal injections
  • May be painful; consider topical anesthesia before procedure
  • Contraindicated in pregnancy and neuromuscular disorders

Step 4: Systemic Medications

For severe cases or when topical treatments and injections fail:

• Oral glycopyrrolate (1-2 mg once or twice daily) 1, 4, 6
• Oral oxybutynin (start with 2.5 mg daily, increase as needed) 1
• Clonidine (0.1 mg twice daily) as an alternative 4

Step 5: Procedural Interventions

For severe, treatment-resistant cases:

• Microwave thermolysis for axillary extension 1
• Local surgical options such as curettage or liposuction to remove sweat glands 3, 4

Special Considerations

• Pregnancy and breastfeeding: Topical aluminum chloride is preferred; avoid systemic anticholinergics 2
• Secondary causes: Rule out underlying conditions (thyroid disorders, diabetes, medications) 3, 7
• Skin infections: Treat any secondary bacterial or fungal infections promptly with appropriate antimicrobials

Common Pitfalls to Avoid

• Inadequate drying before applying aluminum chloride significantly reduces its effectiveness 1
• Stopping treatment too soon after initial improvement can lead to symptom recurrence 1
• Ignoring psychological impact - hyperhidrosis can cause significant psychosocial stress and reduced quality of life 3, 6
• Failing to consider clothing modifications which can significantly improve symptoms 2, 1

By following this structured approach, most patients with hyperhidrosis under the breast can achieve significant symptom improvement and better quality of life.