Dr. Presser
What Is Hyperhidrosis? Hyperhidrosis, or excessive sweating, is a common disorder which can produce a lot of unhappiness. An estimated 2-3% of Americans suffer from excessive sweating of the underarms (axillary hyperhidrosis) or of the palms and soles of the feet (palmoplantar hyperhidrosis). Underarm problems tend to start in late adolescence, while palm and sole sweating often begins earlier, on average around the age 13. Untreated, these problems may continue throughout life.
Sweating is embarrassing. It stains clothes, ruins romance, and complicates business and social interactions. Severe cases can have serious practical consequences as well, making it hard for those who suffer to hold a pen, grip a car steering wheel, or shake hands.
What Is the Cause of Hyperhidrosis? Although neurologic, metabolic, and other systemic diseases can sometimes cause hyperhidrosis, most cases occur in people who are otherwise healthy. Heat and emotions may trigger hyperhidrosis in some, but many who suffer sweat nearly all their waking hours, regardless of their mood or the weather.
Treatment. Several treatment options are available for hyperhidrosis. Your doctor will work with you to find the least invasive treatment to relieve symptoms.
Antiperspirants. Strong antiperspirants plug the sweat ducts and can be effective. Products containing 10% to 20% aluminum chloride hexahydrate are the first line of treatment. Some patients may be prescribed a product containing a higher dose of aluminum chloride, which is applied nightly onto the affected areas. Antiperspirants can cause skin irritation and large doses of aluminum chloride can damage clothing. Note: Deodorants do not prevent sweating, but are helpful in reducing body odor.
Medication. Anticholinergics drugs, such as glycopyrrolate (Robinul, Robinul-Forte), help to prevent the stimulation of sweat glands. Although effective for some patients, these drugs have not been studied as well as other treatments. Side effects include dry mouth, dizziness, and problems with urination. Beta-blockers or benzodiazepines may help reduce stress-related sweating.
Iontophoresis. This FDA-approved procedure uses electricity to temporarily turn off the sweat gland. It is most effective for sweating of the hands and feet which are placed into water, and a gentle current of electricity is passed through it. The electricity is gradually increased until the patient feels a light tingling sensation. The therapy lasts about 10-20 minutes and requires several sessions. Although rare, side effects can include skin cracking and blisters.
Botox. Botulinum toxin type A (Botox) is FDA approved for the treatment of severe underarm sweating. Small doses injected into the underarm temporarily block the nerves that stimulate sweating. Side effects can include injection-site pain and flu-like symptoms. Botox used for sweating of the palms can cause temporary weakness and/or intense pain.
Surgery. In severe cases where other treatments fail, a minimally-invasive surgical procedure called sympathectomy may be recommended. Sympathectomy is an operation intended to destroy part of the nerve supply to the sweat glands in the skin. The procedure turns off the signal that tells the body to sweat excessively. Sympathectomy is 85-95% effective for palmar (hand) hyperhidrosis. As with any surgical procedure, educate yourself, understand the procedure and trust your surgeon.
Dr. Presser is a thoracic surgeon specializing in minimally invasive procedures. He is an advocate for prevention and encourages lung cancer screenings which are proven to save lives. He welcomes your questions and can be reached at 760.424.8224.
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