Of sweating and hyperhidiosis
The question
In the US alone, approximately 7.8 million people suffer from hyperhidrosis, a condition characterized by excessive sweating around a general or specific area, such as the hands, feet, armpits, and groin. These areas contain a very high concentration of sweat glands and thus increase perspiration from these areas, causing significant problems for those affected, both personally and professionally. The condition ruins relationships, stains clothing, and creates problems with business and social interactions. Severe cases could have an even more negative impact, such as making it difficult for patients to hold a pen or grip the steering wheel. In sports, this condition makes it difficult for patients to catch a baseball, basketball, or soccer ball.
what you need to know
Although neurological, endocrine, infectious, and other systemic diseases can sometimes cause hyperhidrosis, most of the time people with this condition are healthy. Triggers like heat and emotions can cause hyperhidrosis in some, but a large number of hyperhidrosis sufferers sweat virtually every waking hour, regardless of their mood or the weather. Nervousness or excitement can make things worse for many people who have it. Certain foods and drinks, nicotine, caffeine, and odors can also trigger hyperhidrosis.
The way in which hyperhidiosis has been treated has generally proceeded as follows:
1. Over-the-counter antiperspirants that generally contain aluminum are usually tried first because they are quite affordable. Antiperspirants that contain aluminum chloride, such as Certain Dri, may be more effective if other antiperspirants haven’t worked.
2. Prescription antiperspirants containing aluminum chloride hexahydrate (Drysol).
3. Iontophoresis, a system that spreads ionized tap water through the skin using direct electricity.
4. Oral medications such as anticholinergics to reduce sweating.
5. Botox (botulinum toxin)-A, was approved in the US by the FDA to treat excessive axillary (underarm) sweating.
6. As a last resort, a procedure called a thoracic sympathectomy is sometimes considered.
When regular antiperspirants fail to treat excessive sweating, most doctors start by recommending Drysol, a prescription-strength version of aluminum chloride. Sufferers apply it to affected areas just before bedtime 2-3 nights in a row, then usually once a week thereafter to maintain improvement. This treatment works relatively well for many patients whose problem is excessive underarm sweating, but it does not work well for most who have sweaty palms and soles.
The main side effect of Drysol is irritation, which can sometimes, but not always, be prevented by ensuring the skin is dry before applying and allowing the medication to dry completely afterwards. Also, reducing the use of lotions containing corticosteroids may help minimize irritation.
Iontophoresis was introduced more than 50 years ago as a treatment option for excessive sweating. Its exact mechanism of action is not yet fully understood, although it is believed to be due to temporary blockage of the sweat duct. The procedure uses water to conduct an electrical current to the skin several times a week, for about 10 to 20 minutes per session, followed by follow-up treatments at 1 to 6-week intervals, depending on patient response and the device used. .
Oral anticholinergic medications such as glycopyrrolate (Robinul) are not often used to treat hyperhidrosis because side effects include dry mouth and blurred vision.
Botulinum toxin A (Botox), a nerve toxin that can temporarily paralyze muscles, is frequently in the news as a cosmetic treatment for wrinkles. One may be surprised that it has actually been used in many areas of medicine for many years, including for the treatment of muscle spasms and certain types of headaches. Its latest medical use is for the treatment of excessive underarm sweating.
Although the FDA has not approved Botox to treat sweaty palms and feet, they have approved it to prevent excessive underarm sweating. The treatment involves injecting a small amount of Botox with a fine needle into about 25 to 20 places in each armpit, resulting in six months of relief from sweating. With FDA approval, many insurance companies now provide coverage for injections and Botox itself after other treatment options have failed.
Sympathectomy is an operation that removes a part of the nerves from the sweat glands in the skin. The surgeon inserts a special scope into the chest between two ribs just below the armpit. This procedure can be both effective and risky as even with the latest endoscopic techniques, complications including excessive sweating in other parts of the body, lung and nerve problems create an even more serious health threat. Due to the fact that many of these complications are serious and non-reversible, this option is rarely used, and only as a last resort.
What do you need to do
As with any health problem, discuss and plan your course of action with your doctor or, in the case of athletic departments, the team doctor. That said, iontophoresis is an option to seriously consider as the technology and success rate continue to increase with limited complications involved.