Treatment for Hyperhidrosis (excessive sweating) What is hyperhidrosis? Hyperhidrosis is excessive sweating, far beyond what is normally required to control body temperature. Everyone sweats to some extent. Sweating is an important mechanism that helps the body to control its temperature and hydrate the skin. It is usually tightly controlled so that just enough moisture is released which will then evaporate from the surface of the skin. This action helps to keep us cool. We sweat more when exercising and this can result in our bodies becoming damp because the moisture cannot evaporate fast enough.

Excessive sweating, or hyperhidrosis, results in moisture accumulating on the surface of the skin instead of evaporating as it normally would. It can occur on any part of your body but most often occurs in the armpits, palms of the hands, soles of the feet, forehead, upper lip and trunk.

Patients with hyperhidrosis often complain of having to wash more frequently and change clothes several times each day. It may also cause embarrassment and inconvenience socially and at work, adversely affecting quality of life.

Some patients may report other family members who have a similar condition, suggesting a possible genetic link.

It is not completely clear what causes hyperhidrosis and why it only affects part of a person’s body. Research has not shown any changes to the structure of the sweat glands in the affected areas or how they respond to signals from the brain. It is thought dysfunction of the hypothalamus (part of the brain involved with temperature regulation) may be a contributory factor.

For most people the usual causes of sweating might be exercise, some foods especially spicy foods, types of clothes and possibly stress. For those suffering from hyperhidrosis there may be no apparent trigger to their increased sweating. Indeed someone with hyperhidrosis is just as likely to sweat too much when it is cold as when it is hot and stress is not normally a trigger. However, most sufferers do find the condition distressing and this may worsen their condition.

What treatments are available?

Topical agents
Talcum powder and cornstarch powder (e.g. Zeasorb® ) can be helpful in absorbing the sweat in mild cases.

Stronger antiperspirants containing aluminium chloride e.g. Driclor ® and AnHydrol Forte® can be used for armpits, hands and feet. They are applied 2-3 times a week at night and washed off in the morning to avoid damage to clothes. Application can be effective especially for underarm sweating. However they can cause the skin to become irritated over time. If this happens you should consult your doctor.

At the Eden Clinic, our preferred treatment for hyperhidrosis which has not responded to the above methods is botulinum toxin type A injections:

Botulinum Toxin Type A injections
Botulinum Toxin Type A is an effective treatment for hyperhidrosis. It involves injecting small doses of Botulinum Toxin Type A into the skin of the affected areas. It works by blocking the action of nerves that supply the eccrine (sweat) glands. This stops the glands from producing sweat. Treatment totally blocks the nerve ending for about 6-12 weeks but then new nerve endings start to form. This means the effects of treatment last for several months but will eventually wear off.

What does treatment involve?
Treatment involves a number of small injections with a fine needle into the affected areas eg armpits.The injections may cause some discomfort and your skin may be slightly red and inflammed immediately after treatment. This normally resolves within a few hours.

Are there any side effects?
Side effects include bruising or tenderness at the injection sites and increased sweating at other sites. Rare side effects include itching, muscle aches, allergic reactions and muscle weakness.

How long does it take to work?
Most patients notice some positive changes within the first week after treatment. The effects usually last 4-7 months.

Other treatments for hyperhidrosis include:

Iontophoresis
Iontophoresis involves immersing the sites of hyperhidrosis in warm water through which a mild electric current is run. Some clinicians add the anticholinergic glycopyrrhonium bromide to enhance the effects.  A person’s natural electrical charge being negative, positive ions in the water, flow straight through the sweat ducts, interrupting the sweating process by an unknown mechanism.  It is a treatment that has been in clinical use for several decades, and is not dangerous.  Few people report any discomfort, save some tingling, and sometimes a dry mouth.  (For safety’s sake, anyone who is pregnant, has an orthopaedic implant, or has problems with their heart or breathing should not undergo iontophoresis.)  However, there is currently little published evidence of its efficacy. It usually requires multiple treatment sessions and maintenance sessions as necessary.

Surgery
There are two types of surgery:

• Subcutaneous sweat gland curettage This is the surgical removal of the over active sweat glands under anaesthetic. It is generally thought to reduce sweating by up to 50% in sufferers.
• Transthoracic sympathectomy (cutting of the nerves that supply the glands)
  A direct electrical current is applied through a laparoscope (key hole surgery) to cause destruction of tissue and if needed partial removal of the involved nerve fibres and ganglia in the spine (t2 and t3) under general anaesthetic, to provide long-term elimination of palmar (hands) and axillary hyperhidrosis. It is highly effective at stopping the sweating on the palms and under the arms but there is between 40-69% risk of compensatory hyperhidrosis (new areas of excessive sweating, usually on the trunk and lower parts of the body). Patients are usually required to stay in hospital overnight.