How Hyperhidrosis Is Treated

There is a wide range of available options for the treatment of hyperhidrosis, a condition involving excessive sweating. Many people with hyperhidrosis may avoid pursuing medical treatment because of embarrassment or a false belief that nothing can be done about the condition. But there are several viable treatment options that vary in their mode, efficacy, duration, possible side effects, and cost.  

Today's treatment options for hyperhidrosis include a wide range of modalities, including:

  • Prescription antiperspirant
  • Other prescription medication
  • Topical (on the skin) treatments
  • Injections
  • Surgical treatments

Over-the-Counter (OTC) Therapies

Regular over-the-counter antiperspirants may be the first treatment a dermatologist recommends for hyperhidrosis. Common antiperspirants containing 1% to 2% aluminum salts are often recommended for application to areas prone to excessive sweating. Antiperspirants work by plugging up the sweat glands, which signals the body not to produce so much sweat. If an over-the-counter type of antiperspirant doesn’t work, your health care provider can prescribe a stronger formula.

You may find examples of natural remedies available over the counter that indicate they may be used for hyperhidrosis. These include:

  • Herbal tea (sage, chamomile or other types of herbs)
  • Valerian root (Valeriana officinalis)
  • St. John’s wort (Hypericum perforatum)

There is a lack of medical research data to back the claims of safety or efficacy of many of these natural/herbal supplements. Before using any type of herbal or natural remedy (such as herbal tea, sage, valerian root, or St. John's wort) it is important to consult with your primary healthcare provider.

Prescriptions

Prescription Topical Treatments

The treatment of choice for those with mild to moderate focal hyperhidrosis (the genetic type of hyperhidrosis involving one or more focal areas of sweating in the body) is topical treatment of aluminum chloride hexahydrate. Studies have shown that aluminum chloride hexahydrate is considered first-line therapy for patients with mild-to-moderate hyperhidrosis. This medication is available as an antiperspirant that works by impacting the cells that produce sweat. Medications with aluminum chloride are available in concentrations of 15% to 25%. The applications must be repeated daily.

Possible Side Effects

Common side effects of aluminum chloride hexahydrate may include skin irritation and a localized burning or stabbing sensation. In fact, the primary reason that aluminum chloride hexahydrate is discontinued in cases of mild focal hyperhidrosis is because it commonly causes severe irritation to the skin. Washing the medication off at night and reapplying it the next day can help to lower the incidence of irritation.

Another type of prescription antiperspirant is available that is said to result in a decrease in skin irritation: aluminum chloride hexahydrate in a salicylic acid gel. A 2009 study revealed that the treatment combining 15% aluminum chloride hexahydrate with 2% salicylic acid in a gel base significantly decreased irritation in people with hyperhidrosis, however, this combination formula is not readily available.

A more practical approach would be to apply OTC hydrocortisone 1% cream for any irritation that develops after the use of aluminum chloride products.

Anticholinergic Solutiosn

For both focal hyperhidrosis and another type of sweating called gustatory sweating (seen in those with diabetes or Frey’s syndrome), Qbrexza cloths with a topical solution of 2.4% glycopyrronium may be used. Glycopyrrholate is an anticholinergic substance, which inhibits the transmission of some of the nerve impulses involved in sweating.

Note: Generally, topical medicated antiperspirants and solutions are only used to treat primary focal hyperhidrosis and not generalized hyperhidrosis.

Iontophoresis

Iontophoresis is a procedure that involves placing the feet and hands in a basin of water with an electrical current that passes through. It is commonly used to treat palmoplantar hyperhidrosis (because the hands and feet can easily be submerged in water). It is thought that the charged particles in the water help obstruct secretions from eccrine glands (small sweat glands).

In a 2017 study, iontophoresis was found to be “an effective and safe treatment modality for palmar hyperhidrosis.” The procedure was also found to have very few side effects, including a local skin reaction at the site of treatment involving:

  • Redness
  • Dryness
  • Rash
  • Peeling

The side effects are reportedly easily cured by applying emollients or corticosteroid creams or ointments.

Although iontophoresis treatment usually lasts one to four weeks, the study found that 71.4% (five out of seven) study participants realized improvement in symptoms for a time span of four weeks after the final treatment.

One disadvantage of iontophoresis treatment, for those with limited time, is that the treatment sessions are long and are usually required several days per week. For example, treatment sessions may last between 30 to 40 minutes for each appointment and are ordered as often as 4 days each week. Improvements are usually seen after six to ten treatments. 

Note, those who have a pacemaker or women who are pregnant should not receive iontophoresis treatments.

Botulinum Toxin A Injections

Botulinum toxin A (commonly referred to as Botox) is a treatment involving a neurotoxin which is injected intradermally (between the skin layers) into the area a person is experiencing sweating. It’s used for plantar and palmer sweating, but is most useful to treat axillary (under the armpit) focal sweating.

The neurotoxin in botulinum toxin A comes from a bacterium called Clostridium botulinum. It works by blocking the nerves that stimulate the sweat glands, resulting in the loss of sweating.

Studies report that after only one week of treatment, 95% of the study subjects (with focal axillary hyperhidrosis) realized a significant improvement in symptoms. In addition, the average length of duration of the effect was seven months. For those with palmar hyperhidrosis, over 90% reported an improvement of symptoms which lasted approximately four to six months after treatment. The study authors noted that the overall satisfaction rating of Botox treatment was 100%.

Possible Side Effects

The primary limitation of botulinum toxin A treatment is that the injections are very painful, requiring nerve blocks to anesthetize the area that is going to be treated. Another limitation is the cost of the medication. But, despite the expense and pain, the treatment is said to provide a high satisfaction rating among those with hyperhidrosis. This may be because the effects last between six to nine months.

Anticholinergic Drugs

The primary type of oral (by mouth) medication used to treat hyperhidrosis is an anticholinergic agent. Anticholinergic drugs work by inhibiting a neurotransmitter (called acetylcholine) known to activate the sweat glands.
Anticholinergic drugs are used to treat specific types of hyperhidrosis, including:

  • Excessive facial sweating
  • Generalized hyperhidrosis (sweating of the entire body)
  • Sweating that does not respond to other treatment (such as prescription antiperspirant, Botox or iontophoresis).

Possible Side Effects

High doses of anticholinergic drugs are usually required to attain the desired effect (reduced sweating). This may result in side effects such as:

  • Dry mouth
  • Constipation
  • Blurred vision
  • Urinary retention
  • Tachycardia (fast heart rate)

Note: Recent studies published in 2015 discovered that anticholinergic agents may cause cognitive impairment in older adults. A few studies suggest that they may also be linked with an increase in the risk of dementia.  Seniors with hyperhidrosis may want to consult with their health care provider about these potential side effects, before taking anticholinergic medications.

According to an overview published by the Canadian Medical Association Journal (CMAJ), an anticholinergic drug called glycopyrrolate, given at initial doses of 1 milligram (mg) two times per day, “may improve hyperhidrosis, but the eventual dosage required usually results in unacceptable side effects.”

Other Prescription Medications

Other systemic (impacting the entire body) medications that have been used for generalized hyperhidrosis include:

  • Amitriptyline
  • Clonazepam
  • Propranolol
  • Diltiazem
  • Gabapentin
  • Indomethacin

Although these medications are commonly used to treat generalized hyperhidrosis, more research is needed to establish the effectiveness of these drugs for treating focal hyperhidrosis.

Surgeries and Specialist Driven Procedures

There are several surgical procedures used to treat hyperhidrosis.

Endoscopic Thoracic Sympathectomy (ESC)

Endoscopic thoracic sympathectomy (ESC) is a procedure that destroys a portion of the nerve tissue involved in the sweating process, called the sympathetic ganglia. The nerve tissue is either cut out, or other surgical methods are used to destroy it, such as cautery or laser. 

Studies have shown that ESC is effective in 68% to 100% of the cases of axillary, palmer (on the palms of the hands) and facial focal hyperhidrosis. Plantar (on the feet) hyperhidrosis was found to be reduced in 58% to 85% of those with focal hyperhidrosis who received the treatment.

Possible Side Effects

The primary side effect (and major limitation) of ESC is a high incidence of what is called severe compensatory hyperhidrosis in the trunk and lower limbs. A 2005 study reports an incidence of up to 86% of those who have the procedure, develop compensatory hyperhidrosis (CS), but a more recent, 2017 study sheds light on who may be at highest and lowest risk. According to the 2017 study authors conclusion, "This study demonstrates that older age, operation level, facial blushing, and high BMI are risk factors for CS, as have been shown in several similar studies. An interesting finding of the present study is that there was a decreased incidence of CS among patients with plantar sweating."

Compensatory hyperhidrosis is a condition in which the body begins excessive sweating in other, broader areas, as a response to the surgically treated areas. The areas involved in compensatory hyperhidrosis commonly involve the chest, back, gluteal (buttocks) area, and the abdomen. Other side effects of endoscopic thoracic sympathectomy include:

  • Phantom sweating (the sensation that sweating is impending, in the absence of any excessive sweat)
  • Neuralgia (nerve pain)
  • Horner’s syndrome
  • Pneumothorax (collapsed lung)
  • Sexual dysfunction (linked to lumbar [lower back] sympathectomy for plantar hyperhidrosis)

Other surgical procedures for focal hyperhidrosis include:

  • Liposuction
  • Axillary (under the arm) curettage
  • Excision of axillary (under the arm) tissue

Note: Because of the high incidence of severe, long-term side effects (such as compensatory hyperhidrosis), surgical procedures to treat hyperhidrosis are usually limited to cases in which other, non-invasive treatment modalities (such as prescription antiperspirants, Botox and iontophoresis) have failed.

Home Remedies and Lifestyle

There are ways to deal with excessive sweating that may help.

Baking soda: Baking soda’s alkaline properties enable it to reduce body odor. It can be mixed with water and applied topically (to the skin) in the armpits to reduce odor. Be sure to do a patch test to ensure you do not have an allergic reaction before applying baking soda or any other natural remedy to the skin.   

Diet: Some foods are thought to cause excessive sweating and should be avoided when a person has hyperhidrosis. For example, spicy foods like hot chili (containing capsaicin) stimulate the receptors of the nerves in the skin, tricking the body and making the nervous system sense that the body is hot. The brain then signals the skin to begin sweating, which is its natural way to cool the body down.

Complementary and Alternative Medicine (CAM)

Several complementary and alternative treatment methods have been used to treat hyperhidrosis, however, there is a lack of clinical research data evidence to back the claims of efficacy in their use.

Examples of natural remedies and alternative treatment modalities used to treat hyperhidrosis include:

  • Biofeedback
  • Relaxation techniques
  • Hypnosis
  • Acupuncture

A Word From Verywell

The treatment options for hyperhidrosis may be confusing, simply because there are so many options. To simplify, here is a summarization, in order of the most to least effective treatments (according to the clinical research studies):

  • The first line of defense for primary focal axillary (under the armpit) hyperhidrosis (the most prevalent form of the condition) is some type of aluminum chloride-based topical antiperspirant treatment. Aluminum chloride-based antiperspirants are also considered the first-line treatment for palmar and plantar hyperhidrosis.
  • If aluminum chloride-based antiperspirants don’t work, or if the side effects are intolerable, the second-line treatment for palmar and plantar hyperhidrosis is Qbrexza.
  • The most effective treatment—according to patient response surveys—is Botox (botulinum toxin A). But this type of treatment can be costly and extremely painful.
  • Medications, such as anticholinergic drugs, have been used to treat secondary generalized hyperhidrosis, but they lack enough clinical research to prove their safety and effectiveness. Systemic medications (those that impact the entire body), such as anticholinergic drugs should only be used to treat those with hyperhidrosis symptoms that do not respond to other types of treatment.
  • Many other drugs have been used to treat hyperhidrosis, but there is a lack of clinical research evidence to prove they are effective.
  • Surgical intervention is the last resort for those whose condition does not respond to any other type of treatment. This is because of the high incidence of severe, long-term side effects of surgical procedures, such as compensatory hyperhidrosis.
  • The safety and efficacy of natural/alternative treatment methods for hyperhidrosis has not yet been well established or backed by clinical research data.

It’s important to note that in some cases (such as secondary generalized hyperhidrosis) there is an underlying cause that, when diagnosed and treated, may stop the sweating, without any specific hyperhidrosis treatment modalities. 

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