What's New in the Treatment of Hyperhidrosis (Excessive Sweating):
Hyperhidrosis is the medical term for an excessive amount of sweat, and it can affect the underarms, the groin, or localized regions of the body such as the back or legs. It can be caused by other medical compenconditions, such as infections or endocrine disorders, in which case it is called secondary hyperhidrosis, or it can be genetic, whereby it is a trait that runs in certain families, in which case it is called primary hyperhidrosis.
Hyperhidrosis affects all ages, but it's more concerning among people who have to be in the public arena - like the woman in the photo above - because profuse sweating stains clothing.
Dermatologists often consider running certain blood tests for people suffering from hyperhidrosis, to look at endocrine, nutritional, or metabolic causes of the excessive sweating. These may include liver and kidney functions, blood counts, and endocrine tests, such as thyroid functions. If the hyperhidrosis is found to be secondary to another condition, then management of that condition will often help the excessive sweating.
Fortunately, over the last 10-15 years, Dermatologists have uncovered a growing number of management options for primary hyperhidrosis:
For many years, an oral tablet called glycopyrrolate, an anticholinergic drug, has proven helpful for management of many patients with hyperhidrosis. In 2018, a promising new form of this category of medications - Qbrexza® - also became available for use on top of the skin
We often use both over-the-counter and prescription aluminum chloride-containing antiperspirants - Drysol® and Certain Dri® - to help to control excessive sweating.
There is an electrical current treatment device that uses a process called iontophoresis to control excessive sweating – a treatment which generally has to be done every day at home for two to three weeks – then at least twice a week.
There is a microwave technology piece of equipment called a Miradry® machine which can often permanently reduce underarm sweating. In certain cases, this treatment has to be done on more than one occasion.
There is a surgical option – called endoscopic thoracic sympathectomy – which can control more severe cases – but this has to be done under general anesthesia – and it has the notable side-effect of promoting excessive sweating in other parts of the body (compensatory hyperhidrosis) – to this option is considered a last resort treatment.
For more severe cases, Dermatologists often consider use of Botulinum A injections – or Botox® injections – to prevent the nerves in the affected areas of the body from releasing excessive amounts of sweat. This therapy often has to be repeated every 6-12 months.
Botox injections are surprisingly well-tolerated by most patients. Though generally helpful in reducing sweating, this treatment is not a permanent cure.
So if you or a family member suffers from excessive sweating, consider seeing a Dermatologist in your area. You can find a member of the American Academy of Dermatology by going to AAD.org, and finding the tab for “Public,” then searching under your zip code. Or if you’re in the Memphis TN area, consider sending us an Email (Info@rheumderm.com), or call 1-901-753-0168 for an appointment.
George Woodbury Jr. M.D. (12/27/2018)