Hyperhidrosis is the medical term for excessive sweating. The problem may be limited to a few problem areas or may be all over. The armpits and the palms are the areas most often troublesome. Excessive sweating starts after puberty. It may be present to some degree all the time, but is at its worst when under stress such as during exams, interviews or dating. Excess sweating that affects areas other than the armpits and palms may a sign of serious problems. Systemic, neurological and anxiety conditions need to be ruled out; however most cases have no underlying cause.
Most over-the-counter antiperspirants are not strong enough to do the job. The best topical product, Drysol, is available by prescription. It may be somewhat irritating and sometimes takes a while to get used to it. Drysol is applied at bedtime to completely dry skin and washed off in the morning shower. Do not use a regular deodorant afterwards. Repeat the treatment nightly until the sweating is under control. If it does not work after one or two weeks, begin covering the affected area with a square of "saran wrap" overnight. After it begins to work, use once or twice weekly to maintain the effect, and use a regular deodorant on the other days. The medication is less effective on the thick skin of the palms and soles.
If this treatment doesn't work well enough there are alternatives. Botox injections, a treatment popular for wrinkles, will control excessive sweating for 4 to 6 months. Botox is a purified protein which has the ability to block the chemical which activates sweat glands. The FDA has approved this treatment for underarm hyperhidrosis. Many insurances are now covering the cost of Botox for this condition. Some physicians are using Botox for sweating of the palms, however sometimes it may cause a temporary weakness of the grip.
Another treatment option is iontophoresis. This is especially good for palmar sweating in people who do not respond well to topical products. Iontophoresis uses an electrical device connected to a water bath. Hands are placed in the bath and a weak electrical current is conducted through the skin which inhibits sweating. There are no significant side effects from long term use of this device. For mild hyperhidrosis, the battery powered Drionic device may be helpful, and can be purchased without a prescription. A stronger option is the plug in iontophoresis unit, which does need a prescription. In the US, it may be rented or purchased from the R.A. Fischer Company.
People who have not had success with the above treatments may consider oral medications, including Robinul and Pro-Banthine pills. This is an especially good option when someone has generalized sweating. These drugs are fairly safe but may have some annoying side effects including dry mouth, constipation, urine retention, blurring of vision, and heart palpitations. Since these side effects are dose dependent, it’s best to start with a low dose and slowly increase the dose if needed.
A surgical procedure called 'endoscopic thoracic sympathectomy' can cure hyperhidrosis of the palms. An experienced surgeon must do it. It may cause some increased sweating on other parts of the body, but most patients don't seem to be bothered by this. Some liposuction surgeons know a special technique to scrape out the sweat glands from the armpits. These treatments should be discussed in detail before they are considered.
A novel treatment for hyperhidrosis is miraDry. It was approved by the FDA in 2011 for excessive underarm sweating. This treatment uses a hand held device which delivers electromagnetic energy non-invasively to the area where the sweat glands reside. As a result the glands are destroyed and don’t grow back, resulting in a dramatic and lasting reduction of underarm sweat.
The newest treatment for underarm sweating is glycopyrronium cloths (Qbrexza). This is a pre-moistened medicated cloth towelette that comes in individually wrapped packets. When wiped under the arm the solution enters the affected area to inhibit neurotransmitters on the sweat glands, reducing the amount of sweat produced. It is used once daily.
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