From the Guidelines
Hyperhidrosis treatment should prioritize avoiding extreme temperatures and using regular topical skincare, as well as considering oral retinoids in cases with severe thermodysregulation, as recommended by the European guidelines of care 1. When managing hyperhidrosis, it's essential to consider the severity of the condition and the affected body area.
- For mild cases, simple measures such as avoiding extreme temperatures and outdoor activities during the hottest periods of the day can be beneficial.
- Wearing adequate clothing and using cooling devices like air conditioning or fans can also help to cool the skin.
- Regular topical skincare is recommended, although the effects of local and systemic therapy on sweat glands are not well known 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. Key considerations in hyperhidrosis treatment include:
- Avoiding extreme temperatures and outdoor activities during the hottest periods of the day
- Wearing adequate clothing
- Using cooling devices like air conditioning or fans
- Regular topical skincare
- Considering oral retinoids in cases with severe thermodysregulation It's crucial to weigh the potential benefits and risks of each treatment option, considering the individual patient's response and the severity of their condition, as recommended by the European guidelines of care 1.
From the FDA Drug Label
Patients should be informed that heat prostration (fever and heat stroke due to decreased sweating) can occur when anticholinergics such as oxybutynin chloride are administered in the presence of high environmental temperature. Oxybutynin can be used to treat hyperhidrosis as it can decrease sweating, but it may cause heat prostration in high environmental temperatures.
- Key considerations:
- Use with caution in high temperatures
- Monitor for signs of heat prostration
- Inform patients of the risk of heat prostration 2
From the Research
Hyperhidrosis Treatment Options
- Topical medications, such as aluminum chloride, are commonly used to treat hyperhidrosis 3, 4, 5
- Iontophoresis is a treatment option for palmoplantar hyperhidrosis, with high efficacy but also high initial costs and inconvenience 3, 6, 5
- Botulinum toxin injections are used to treat axillary, palmar, plantar, and craniofacial hyperhidrosis, with high efficacy but also potential pain and anesthesia-related complications 3, 6, 5
- Systemic medications, such as glycopyrrolate and clonidine, are used to treat hyperhidrosis, particularly in severe cases or when other treatments fail 3, 6
- Surgery, including endoscopic thoracic sympathectomy (ETS), is considered a last-line treatment option for severe cases of hyperhidrosis that have not responded to other therapies 3, 6, 5
Treatment Algorithms
- For axillary hyperhidrosis, the recommended treatment algorithm is: topical treatment as first-line, botulinum toxin injections as second-line, oral medications as third-line, local surgery as fourth-line, and ETS as fifth-line 3
- For palmar and plantar hyperhidrosis, the recommended treatment algorithm is: topical treatment as first-line, oral medications as second-line, iontophoresis as third-line, botulinum toxin injections as fourth-line, and ETS as fifth-line (only for palmar hyperhidrosis) 3
- For craniofacial hyperhidrosis, oral medications are considered first-line therapy, with topical medications or botulinum toxin injections as alternative options 3, 6