From the Guidelines
Hyperhidrosis of the feet should be managed with a combination of daily hygiene measures, antiperspirants, and other treatments as needed, prioritizing the reduction of morbidity, mortality, and improvement of quality of life. When considering the treatment of hyperhidrosis of the feet, it is essential to prioritize approaches that minimize the risk of complications and maximize the improvement in quality of life. Although the provided evidence 1 primarily focuses on the management of hyperkeratosis and corns in patients with epidermolysis bullosa, it highlights the importance of careful foot care and the use of emollients and nonadherent dressings to protect the skin. In the context of hyperhidrosis, daily hygiene measures such as washing feet with antibacterial soap, drying thoroughly, and applying antiperspirants containing aluminum chloride can help reduce sweat and prevent infections. Key considerations for managing hyperhidrosis of the feet include:
- Daily hygiene practices to reduce bacterial and fungal growth
- Use of antiperspirants with aluminum chloride to reduce sweat
- Wearing moisture-wicking socks and breathable shoes to minimize moisture accumulation
- Potential use of iontophoresis devices, oral medications, or botulinum toxin injections for more severe cases, as these treatments can provide significant relief by blocking sweat gland stimulation or disrupting nerve signals to sweat glands. Given the potential for complications such as skin infections or discomfort, it is crucial to approach the treatment of hyperhidrosis with a focus on minimizing morbidity and improving quality of life, even if the provided evidence does not directly address hyperhidrosis treatment 1.
From the Research
Treatment Options for Hyperhydrosis of Feet
- Conservative therapies such as topical solutions (e.g., antiperspirant applications and aluminum chloride preparations) and iontophoresis are the first line of treatment for plantar hyperhidrosis 2
- Botulinum toxin type A injections are an effective and safe treatment for plantar hyperhidrosis, especially when conservative therapies have failed 2, 3, 4
- Iontophoresis is a primary remedy for palmar and plantar hyperhidrosis, and can be considered as a second- or third-line treatment option 3, 4, 5
- Oral systemic agents, such as glycopyrrolate and clonidine, can be used as second-line therapy for palmoplantar hyperhidrosis due to their low cost, convenience, and emerging literature supporting their excellent safety and reasonable efficacy 4
- Energy-delivering devices, such as lasers, ultrasound technology, microwave thermolysis, and fractional microneedle radiofrequency, may also be utilized to reduce focal sweating, although their use in treating hyperhidrosis of the feet is not well established 3
- Surgery, including local surgical techniques and sympathectomy, may be considered when more conservative treatments have failed, although it is not recommended for plantar hyperhidrosis due to anatomic risks 3, 4, 6, 5
Step-by-Step Approach to Treatment
- Local treatment options with few and minor side effects, such as topical aluminum chloride solution and iontophoresis, should be tried first 6, 5
- Botulinum toxin injections and oral systemic agents can be considered as second- or third-line treatment options, depending on the severity of the condition and the patient's response to initial treatments 2, 3, 4, 5
- More invasive treatments, such as surgery, should be reserved for severe cases of hyperhidrosis that have not responded to topical or medical therapies 3, 4, 6, 5